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New Hampshire 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 $219–$4680%20%40%10th90th$398Professionalmedian $234 · 10th–90th $145–$3630%20%10th90th$234$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
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $263.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $190.55 / $316.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $426.58 / $478.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $177.83
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 / $630.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $144.54 / $190.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $223.87 / $338.84
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $549.54