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Texas 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 $240 · 10th–90th $129$8320%10%20%10th90th$240Professionalmedian $145 · 10th–90th $126$2340%20%40%10th90th$145$0.2$1.0$5.0$20.0$100.0$500.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $141.25 / $223.87
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $173.78 / $173.78
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $295.12 / $295.12
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 / $181.97
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,584.89 / $1,584.89
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,187.76 / $2,187.76
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $263.03 / $436.52
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $151.36 / $316.23
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $199.53
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $245.47 / $436.52
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $131.83 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $208.93 / $338.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $173.78 / $208.93
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $295.12 / $295.12