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Michigan 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 $398 · 10th–90th $182–$1,2880%20%10th90th$398Professionalmedian $182 · 10th–90th $132–$3240%20%10th90th$182$0.2$1.0$5.0$20.0$100.0$500.0$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
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $173.78 / $245.47
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $977.24 / $1,862.09
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $338.84
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $190.55
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 / $181.97 / $363.08
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $616.60 / $691.83
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $257.04 / $398.11
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $186.21 / $323.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $263.03 / $398.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $151.36 / $229.09