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Nebraska 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 $339 · 10th–90th $145–$1,5490%10%20%10th90th$339Professionalmedian $219 · 10th–90th $115–$9330%10%20%10th90th$219$100.0$200.0$500.0$1.0K$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
$218.78 / $218.78 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $218.78 / $1,698.24
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $338.84 / $338.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $380.19 / $588.84
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $380.19 / $1,548.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $173.78 / $346.74
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$380.19 / $380.19 / $933.25
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $870.96 / $933.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $173.78 / $338.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $165.96 / $269.15