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Maine 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
Professional
Modifier
Low / Median / High Price
$169.55 / $235.54 / $235.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$345.14 / $447.16 / $828.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.26 / $185.73 / $185.73
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 / $132.76 / $181.86
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.19 / $314.19 / $314.19
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.51 / $235.54 / $235.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.48 / $143.90 / $143.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.06 / $193.60 / $445.22