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Minnesota 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 $380 · 10th–90th $275–$2,3440%20%10th90th$380Professionalmedian $324 · 10th–90th $162–$3720%50%10th90th$324$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
$223.87 / $223.87 / $223.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $186.21 / $245.47
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $323.59 / $416.87
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $323.59 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $1,202.26 / $2,884.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $426.58 / $478.63
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $1,202.26 / $2,344.23
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $512.86
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $323.59 / $1,548.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $144.54 / $380.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2.29 / $144.54 / $478.63
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $169.82 / $457.09