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Mississippi 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
$164.15 / $164.15 / $261.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.77 / $187.23 / $261.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.97 / $226.97 / $226.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.97 / $226.97 / $226.97
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.33 / $143.90 / $143.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $139.05 / $223.75