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Ohio 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 $174–$5620%20%10th90th$339Professionalmedian $170 · 10th–90th $132–$2950%20%40%10th90th$170$0.2$1.0$5.0$20.0$100.0$500.0

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
$173.78 / $269.15 / $302.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $162.18 / $223.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $346.74 / $707.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $194.98 / $426.58
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $251.19 / $354.81
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $263.03 / $398.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $190.55
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $181.97
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $181.97
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $316.23 / $467.74
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$398.11 / $398.11 / $398.11
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $371.54 / $676.08
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $263.03 / $398.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $151.36 / $223.87