HCPCS L0622

Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated

Current code23 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

Prices for HCPCS L0622 by hospital
HospitalCommercial insurance rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27$318 – $2,46416 plans——
Deaconess Medical CenterSpokaneFile dated 2026-08-27$441 – $1,5349 plans——
Harborview Medical CenterSeattleFile dated 2026-04-01$590 – $7372 plans$451$645
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01$556 – $1,0355 plans——
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27$318 – $2,7057 plans——
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27$309 – $1,59217 plans——
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27$309 – $1,59217 plans——
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27$358 – $1,59212 plans——
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27$353 – $1,53010 plans——
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01$338 – $1,01410 plans——
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01$571 – $1,2239 plans——
Providence Centralia HospitalCentraliaFile dated 2026-04-01$623 – $1,3785 plans——
Providence Regional Medical Center EverettEverettFile dated 2026-04-01$442 – $8557 plans——
Providence St Peter HospitalOlympiaFile dated 2026-04-01$313 – $1,2038 plans——
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01$553 – $1,3527 plans——
Swedish IssaquahIssaquahFile dated 2026-04-01$553 – $8187 plans——
Swedish Medical CenterSeattleFile dated 2026-04-01$553 – $1,3169 plans——
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01$553 – $1,3169 plans——
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27$309 – $1,59217 plans——
University of Washington Medical CtrSeattleFile dated 2026-04-01$590 – $1,1565 plans$572$816
Virginia Mason Medical CenterSeattle$353 – $1,2827 plans——
Wellfound Behavioral Health HospitalTacomaFile dated 2026-08-27$9301 plan——
Yakima Valley MemorialYakimaFile dated 2026-08-27$318 – $95613 plans——

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Equipment fee, Washington
$369 (fee)