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Wisconsin 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 $331 · 10th–90th $295$6030%50%10th90th$331Professionalmedian $224 · 10th–90th $138$4900%20%10th90th$224$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
$162.18 / $162.18 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $162.18 / $245.47
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $537.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $371.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $758.58 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $467.74 / $616.60
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $263.03 / $407.38
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $416.87 / $524.81
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $323.59 / $1,548.82
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $173.78 / $363.08
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $173.78
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $524.81 / $524.81
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $371.54 / $645.65
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $489.78 / $912.01
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $660.69 / $1,862.09
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $263.03 / $2,041.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $169.82 / $331.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $162.18 / $275.42