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Kansas 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
$288.01 / $288.01 / $288.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.74 / $188.70 / $288.01
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.95 / $280.35 / $297.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.27 / $278.27 / $278.27
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 / $181.86 / $466.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.74 / $280.30 / $1,549.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $172.71 / $444.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $153.10 / $278.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $167.73 / $232.39