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Indiana 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
$159.38 / $159.38 / $322.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.26 / $159.38 / $172.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.41 / $288.23 / $322.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.10 / $177.26 / $239.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.53 / $354.24 / $450.86
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$273.73 / $354.24 / $434.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $181.86 / $322.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.76 / $181.86 / $330.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.33 / $169.40 / $230.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $157.30 / $218.50