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Oklahoma 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
$137.62 / $137.62 / $202.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.52 / $137.62 / $156.12
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 / $181.86
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.74 / $174.80 / $1,549.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $145.19 / $287.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$111.88 / $145.19 / $189.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.80 / $138.72 / $208.31