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Georgia 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 $302 · 10th–90th $138–$1,0960%10%20%10th90th$302Professionalmedian $182 · 10th–90th $135–$3090%20%10th90th$182$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
$138.04 / $138.04 / $354.81
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $165.96 / $263.03
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $707.95 / $1,096.48
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $245.47 / $398.11
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $251.19
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $251.19
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 / $371.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $302.00 / $575.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $144.54 / $239.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $144.54 / $288.40