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Louisiana 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
$157.30 / $166.98 / $224.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$155.22 / $166.98 / $181.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$253.33 / $432.77 / $608.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$172.75 / $206.64 / $206.64
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $181.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.48 / $143.90 / $169.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $138.16 / $222.19