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Utah 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
$93.74 / $93.74 / $93.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.74 / $129.97 / $1,119.63
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 / $187.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.73 / $212.47 / $276.21
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.85 / $284.22 / $284.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$161.85 / $203.73 / $305.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$121.00 / $145.19 / $189.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.69 / $145.19 / $185.91