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Iowa 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 $339 · 10th–90th $182–$8910%20%10th90th$339Professionalmedian $182 · 10th–90th $126–$3310%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
$208.93 / $218.78 / $223.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $173.78 / $263.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $371.54 / $467.74
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $323.59 / $346.74
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $398.11 / $1,548.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $213.80 / $562.34
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $398.11 / $457.09
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $575.44 / $575.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $354.81 / $776.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $173.78 / $323.59
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $338.84 / $338.84