go back

Connecticut 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
$188.61 / $188.61 / $188.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.65 / $140.03 / $188.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.75 / $388.06 / $443.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.26 / $177.26 / $185.73
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 / $181.86
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$252.24 / $252.24 / $252.24
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.18 / $252.24 / $320.14
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.61 / $218.61 / $218.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.92 / $119.92 / $143.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.72 / $193.60 / $322.66