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Washington 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 $363 · 10th–90th $245–$7760%10%20%10th90th$363Professionalmedian $245 · 10th–90th $135–$4790%10%10th90th$245$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
$245.47 / $245.47 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $173.78 / $316.23
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $354.81 / $354.81
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$316.23 / $316.23 / $407.38
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $436.52 / $1,023.29
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $426.58 / $707.95
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $251.19 / $302.00
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 / $398.11
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$316.23 / $524.81 / $724.44
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $354.81
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $354.81 / $354.81
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $316.23 / $407.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $478.63 / $478.63
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $154.88 / $275.42
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $316.23 / $549.54