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North Dakota 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
$211.75 / $211.75 / $211.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.75 / $223.76 / $223.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$272.12 / $321.74 / $329.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.50 / $377.24 / $474.35
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.07 / $223.76 / $1,549.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.95 / $145.19 / $242.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.90 / $143.90 / $143.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $161.19 / $345.42