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Kentucky 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 $182 · 10th–90th $145–$5250%20%10th90th$182Professionalmedian $170 · 10th–90th $132–$2340%20%40%10th90th$170$100.0$200.0$500.0$1.0K

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
$151.36 / $151.36 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $162.18 / $234.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $302.00 / $316.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $169.82 / $177.83
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $398.11 / $512.86
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $363.08 / $467.74
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $524.81 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $208.93 / $1,584.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $204.17 / $263.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $144.54 / $190.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $144.54 / $223.87