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South Dakota 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
$223.76 / $223.76 / $223.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.95 / $218.49 / $223.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $181.86 / $382.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.17 / $373.50 / $466.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.67 / $336.23 / $1,549.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.95 / $185.52 / $381.47
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$318.11 / $382.59 / $558.53
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$313.33 / $387.97 / $731.11
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.77 / $284.22 / $337.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.69 / $173.51 / $345.42
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.85 / $340.85 / $340.85