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California 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 $170 · 10th–90th $132$7590%20%10th90th$170Professionalmedian $174 · 10th–90th $132$1,4790%20%10th90th$174$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
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $173.78 / $1,479.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $169.82 / $758.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $177.83 / $467.74
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $575.44 / $912.01
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $724.44 / $1,445.44
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
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $257.04 / $478.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $354.81 / $630.96
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,584.89 / $1,584.89
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,187.76 / $2,187.76
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $288.40 / $288.40
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $70.79
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $331.13 / $478.63
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $354.81
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $724.44 / $724.44
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $269.15 / $354.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$23.99 / $144.54 / $398.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $173.78 / $398.11