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Kentucky rates for HCPCS L0622

Sacroiliac Orthosis 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
$150.55 / $156.12 / $156.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.22 / $159.38 / $172.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.33 / $292.89 / $307.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$136.99 / $170.43 / $177.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219.68 / $412.99 / $561.41
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.26 / $370.35 / $483.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $181.86 / $380.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.76 / $181.86 / $1,596.19
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.47 / $195.70 / $244.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.06 / $143.90 / $189.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.42 / $145.19 / $205.71