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Alaska rates for HCPCS L0622

Sacroiliac orthosis (SO), flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated

Facilitymedian $174 · 10th–90th $93–$4370%20%40%10th90th$174Professionalmedian $214 · 10th–90th $158–$6170%10%20%10th90th$214$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $208.93 / $389.05
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $524.81
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $288.40 / $436.52
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $436.52 / $1,096.48
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $436.52 / $457.09
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$354.81 / $436.52 / $457.09
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $398.11
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $181.97 / $346.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $190.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $288.40 / $1,122.02