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Colorado 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
Facility
Modifier
Low / Median / High Price
$162.97 / $162.97 / $162.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.65 / $162.97 / $219.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.04 / $327.01 / $593.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.26 / $177.26 / $191.44
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 / $372.17
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.74 / $162.97 / $406.11
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.74 / $93.74 / $93.74
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.46 / $363.80 / $576.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.90 / $143.90 / $169.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.84 / $145.19 / $218.72