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Iowa 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
$211.75 / $223.76 / $223.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.78 / $174.80 / $261.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $181.86 / $382.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.86 / $373.50 / $466.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$292.89 / $322.04 / $347.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.49 / $400.48 / $1,549.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.19 / $173.51 / $456.20
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.47 / $382.59 / $458.54
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.33 / $442.15 / $731.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.92 / $143.90 / $189.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.90 / $173.51 / $409.29
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.85 / $340.85 / $340.85
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.27 / $340.85 / $340.85