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Idaho 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
$152.91 / $316.38 / $316.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $181.86 / $243.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.76 / $132.76 / $187.32
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.74 / $254.52 / $361.32
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.19 / $343.25 / $361.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $266.65 / $317.57
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.38 / $352.85 / $529.28
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.92 / $252.92 / $379.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $167.81 / $189.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.25 / $145.19 / $241.43