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South Carolina 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
$144.97 / $144.97 / $144.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.10 / $144.97 / $256.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.00 / $220.63 / $311.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $181.86 / $200.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.76 / $176.13 / $181.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.34 / $205.48 / $460.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.49 / $205.49 / $205.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.42 / $169.40 / $218.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.42 / $145.19 / $193.60