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Wyoming 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 $158 · 10th–90th $145–$2820%20%10th90th$158Professionalmedian $162 · 10th–90th $138–$2820%20%10th90th$162$100.0$200.0

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
$138.04 / $162.18 / $316.23
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $281.84
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $281.84
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
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $144.54 / $162.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $144.54 / $223.87