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Ohio 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
$172.97 / $172.97 / $489.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.38 / $172.97 / $183.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.39 / $354.24 / $917.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.10 / $175.13 / $418.65
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.53 / $322.04 / $434.75
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.33 / $289.83 / $689.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $181.86 / $380.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.76 / $132.76 / $232.33
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $181.86 / $181.86
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.76 / $181.86 / $181.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.48 / $143.90 / $257.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.11 / $153.94 / $222.19