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Massachusetts 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 $170 · 10th–90th $170–$1,5850%50%90th$170Professionalmedian $219 · 10th–90th $138–$3800%20%10th90th$219$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$169.82 / $169.82 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $169.82 / $263.03
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $380.19 / $1,584.89
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $295.12 / $436.52
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 / $194.98
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $3,630.78 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $512.86
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $218.78
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $380.19 / $1,584.89
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $295.12 / $436.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $186.21 / $398.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $229.09 / $338.84