Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated
Argyle, TX
See all hospitals reporting HCPCS L0622 →Price type
Medical City Argyle’s median price of $312 is 3% below the median hospital's median price ($322), higher than 37% of the 823 hospitals reporting HCPCS L0622. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 25 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Humana tricare fee schedule · outpatient | $288 | $288 | — | — | — | $288 – $288 |
| 2 | Blue Cross Blue Shield mcrppo fee schedule · outpatient | $291 | $291 | — | — | — | $291 – $291 |
| 3 | Blue Cross Blue Shield mgmcrhmo fee schedule · outpatient | $291 | $291 | — | — | — | $291 – $291 |
| 4 | Devoted hmo fee schedule · outpatient | $297 | $297 | — | — | — | $297 – $297 |
| 5 | Devoted mcr fee schedule · outpatient | $297 | $297 | — | — | — | $297 – $297 |
| 6 | Devoted mme fee schedule · outpatient | $297 | $297 | — | — | — | $297 – $297 |
| 7 | Devoted pos fee schedule · outpatient | $297 | $297 | — | — | — | $297 – $297 |
| 8 | Devoted ppo fee schedule · outpatient | $297 | $297 | — | — | — | $297 – $297 |
| 9 | Devoted snp fee schedule · outpatient | $297 | $297 | — | — | — | $297 – $297 |
| 10 | Humana mgmcr fee schedule · outpatient | $297 | $297 | — | — | — | $297 – $297 |
| 11 | UnitedHealthcare mgmcr fee schedule · outpatient | $298 | $298 | — | — | — | $298 – $298 |
| 12 | Aetna mcr fee schedule · outpatient | $299 | $299 | — | — | — | $299 – $299 |
| 13 | Cigna Healthspring mgmcr fee schedule · outpatient | $303 | $303 | — | — | — | $303 – $303 |
| 14 | WellCare mgmcr fee schedule · outpatient | $306 | $306 | — | — | — | $306 – $306 |
| 15 | Superior Healthplan mgmcrdualeligible fee schedule · outpatient | $312 | $312 | — | — | — | $312 – $312 |
| 16 | Superior Healthplan mgmcrhmo fee schedule · outpatient | $312 | $312 | — | — | — | $312 – $312 |
| 17 | Superior Healthplan mgmcrpffs fee schedule · outpatient | $312 | $312 | — | — | — | $312 – $312 |
| 18 | Superior Healthplan mgmcrpos fee schedule · outpatient | $312 | $312 | — | — | — | $312 – $312 |
| 19 | Superior Healthplan mgmcrppo fee schedule · outpatient | $312 | $312 | — | — | — | $312 – $312 |
| 20 | Superior Healthplan mgmcrsnp fee schedule · outpatient | $312 | $312 | — | — | — | $312 – $312 |
| 21 | Molina mcr fee schedule · outpatient | $324 | $324 | — | — | — | $324 – $324 |
| 22 | Molina mme fee schedule · outpatient | $324 | $324 | — | — | — | $324 – $324 |
| 23 | Molina mmp fee schedule · outpatient | $324 | $324 | — | — | — | $324 – $324 |
| 24 | Molina hix fee schedule · outpatient | $778 | $778 | — | — | — | $778 – $778 |
| 25 | Humana comm fee schedule · outpatient | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
Last updated: Mar 1, 2026
See Custom-made flexible sacroiliac support brace pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.