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Georgia 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
$139.10 / $139.10 / $330.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.07 / $175.70 / $243.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$292.89 / $410.06 / $1,074.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.39 / $243.54 / $467.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.97 / $289.20 / $541.87
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.97 / $248.97 / $248.97
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$222.60 / $292.89 / $577.98
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.50 / $143.90 / $161.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.42 / $146.12 / $241.07