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Nebraska 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
$221.80 / $221.80 / $221.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.80 / $221.80 / $288.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$305.69 / $336.25 / $339.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $382.59 / $382.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.86 / $382.59 / $589.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$174.24 / $380.71 / $1,549.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.68 / $173.51 / $289.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.47 / $382.59 / $482.04
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.00 / $446.92 / $788.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.64 / $143.90 / $223.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.30 / $172.71 / $222.16