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Arizona rates for 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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.97 / $155.22 / $256.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.20 / $221.09 / $399.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.00 / $204.00 / $277.95
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 / $132.76 / $373.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.74 / $259.29 / $1,549.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.10 / $145.19 / $218.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $143.90 / $189.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.10 / $145.19 / $218.72