go back

Minnesota 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
$223.76 / $223.76 / $223.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.49 / $223.76 / $223.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$277.56 / $343.73 / $452.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.63 / $305.94 / $322.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $993.17 / $2,758.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.50 / $395.91 / $474.35
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$589.63 / $952.90 / $2,172.00
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.50 / $373.50 / $384.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.55 / $322.04 / $1,549.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $145.19 / $381.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.31 / $143.90 / $145.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $153.94 / $365.84