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Arizona 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 $257 · 10th–90th $69–$5130%10%10th90th$257Professionalmedian $170 · 10th–90th $126–$2630%20%10th90th$170$0.2$1.0$5.0$20.0$100.0$500.0$2.0K

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
$125.89 / $169.82 / $263.03
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $251.19 / $478.63
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $234.42 / $446.68
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 / $181.97
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $257.04 / $1,548.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $144.54 / $1,995.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $316.23 / $316.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $144.54 / $218.78