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South Dakota 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 $219–$3890%20%40%10th90th$224Professionalmedian $245 · 10th–90th $129–$4170%20%10th90th$245$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $223.87 / $223.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $223.87 / $316.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $467.74
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $295.12 / $549.54
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $208.93 / $1,995.26
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $380.19 / $380.19
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $524.81
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $288.40 / $389.05
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $223.87 / $363.08
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $338.84