go back

Indiana 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 $331 · 10th–90th $158–$3630%20%40%10th90th$331Professionalmedian $166 · 10th–90th $135–$2570%20%40%10th90th$166$0.2$1.0$5.0$20.0$100.0$500.0

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
$158.49 / $158.49 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $162.18 / $245.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $331.13 / $407.38
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $177.83 / $316.23
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $380.19 / $436.52
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $190.55 / $263.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $158.49 / $229.09