go back

New Mexico 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 $209 · 10th–90th $93–$3980%10%10th90th$209Professionalmedian $162 · 10th–90th $135–$2630%20%10th90th$162$50.0$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
$141.25 / $141.25 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $162.18 / $245.47
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $234.42 / $275.42
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 / $398.11
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $288.40 / $436.52
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $218.78 / $398.11
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $380.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $162.18 / $398.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $144.54 / $218.78