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Idaho 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 $324 · 10th–90th $170–$4570%10%20%10th90th$324Professionalmedian $224 · 10th–90th $132–$4070%10%10th90th$224$50.0$100.0$200.0$500.0$1.0K$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
$131.83 / $208.93 / $316.23
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $346.74 / $602.56
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $407.38 / $407.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $181.97
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $288.40 / $398.11
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $346.74 / $371.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $309.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $354.81 / $354.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $389.05
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $371.54 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $165.96 / $190.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $144.54 / $223.87