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Vermont 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 $182 · 10th–90th $145–$1820%50%10th$182Professionalmedian $191 · 10th–90th $120–$2190%20%40%10th90th$191$100.0$200.0$500.0$1.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $190.55 / $218.78
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 / $186.21
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $380.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $239.88 / $446.68