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Virginia 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 $347 · 10th–90th $158$4370%20%40%10th90th$347Professionalmedian $178 · 10th–90th $138$2950%20%40%10th90th$178$0.2$2.0$20.0$200.0$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
$138.04 / $169.82 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $169.82 / $257.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $346.74 / $371.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $371.54
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $239.88
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $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
$263.03 / $346.74 / $489.78
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $229.09 / $338.84
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $223.87 / $398.11
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $186.21 / $436.52
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $281.84 / $1,000.00
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $281.84 / $1,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $144.54 / $398.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $169.82 / $281.84