go back

North Carolina 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
$256.48 / $256.48 / $442.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.26 / $256.48 / $256.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$234.83 / $281.80 / $535.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.92 / $219.68 / $219.68
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.74 / $256.48 / $333.42
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.49 / $205.49 / $205.49
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.20 / $349.20 / $537.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.88 / $143.90 / $189.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.52 / $146.12 / $218.72
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$496.74 / $1,843.29 / $1,843.29
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,027.07 / $2,182.80 / $2,182.80