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Oregon 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 $324 · 10th–90th $269$3630%20%40%10th90th$324Professionalmedian $214 · 10th–90th $132$4070%10%10th90th$214$100.0$500.0$2.0K$10.0K

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
$213.80 / $213.80 / $213.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $162.18 / $257.04
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 / $131.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $645.65 / $776.25
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $275.42 / $371.54
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $288.40 / $407.38
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $354.81 / $363.08
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$288.40 / $363.08 / $363.08
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $295.12 / $407.38
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $316.23 / $380.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $575.44 / $1,412.54
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $407.38 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $186.21 / $478.63
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $144.54 / $275.42