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Alaska 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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.88 / $385.88 / $385.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $181.86 / $181.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.76 / $181.86 / $187.32
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.74 / $93.74 / $93.74
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$343.25 / $427.94 / $675.69
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.74 / $93.74 / $181.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.76 / $187.32 / $423.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.90 / $189.98 / $189.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.71 / $430.72 / $561.80