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Delaware 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
$134.22 / $140.03 / $140.03
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $143.90 / $143.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.30 / $169.75 / $255.72