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Massachusetts 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
$169.55 / $169.55 / $169.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.52 / $169.55 / $218.51
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.20 / $1,105.43 / $1,843.29
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.16 / $277.74 / $378.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.10 / $299.16 / $299.16
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 / $373.50
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.19 / $314.19 / $329.90
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.61 / $218.61 / $218.61
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$653.74 / $1,843.29 / $1,843.29
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.06 / $193.60 / $378.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.23 / $143.90 / $189.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.06 / $193.60 / $352.44