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New Hampshire 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
$218.51 / $218.51 / $262.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.03 / $169.55 / $219.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$388.06 / $388.06 / $460.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.26 / $177.26 / $185.73
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.19 / $314.19 / $969.75
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.50 / $151.10 / $169.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.06 / $193.60 / $229.87
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.64 / $319.70 / $406.90