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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$125.89 / $181.97 / $602.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $776.25 / $891.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $218.78 / $416.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $181.97 / $181.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $131.83 / $181.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $177.83 / $398.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $208.93 / $323.59