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Maine 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 $457 · 10th–90th $182–$5250%20%40%10th90th$457Professionalmedian $182 · 10th–90th $129–$3470%10%10th90th$182$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $169.82 / $602.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$380.19 / $457.09 / $524.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $234.42
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 / $181.97
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $407.38
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $173.78 / $234.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $144.54 / $144.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $309.03 / $338.84