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New York 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 $224 · 10th–90th $126$5370%20%10th90th$224Professionalmedian $178 · 10th–90th $126$4270%20%40%10th90th$178$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$100.00 / $234.42 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $162.18 / $234.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $295.12 / $588.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $501.19
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $239.88 / $239.88
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $239.88 / $239.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $380.19
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$295.12 / $489.78 / $1,148.15
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $295.12 / $562.34
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $186.21 / $194.98
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $186.21 / $186.21
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $281.84 / $281.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $169.82 / $831.76
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $194.98 / $501.19
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $173.78 / $194.98
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $186.21 / $186.21