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Montana 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 $282 · 10th–90th $191–$3550%20%40%10th90th$282Professionalmedian $209 · 10th–90th $132–$3550%10%10th90th$209$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
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $169.82 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $309.03 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $309.03 / $309.03
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $281.84 / $549.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $281.84 / $549.54
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $275.42 / $398.11
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $229.09 / $346.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $181.97 / $190.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $144.54 / $223.87