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Virginia 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
$139.26 / $168.23 / $168.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.07 / $168.23 / $175.78
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.25 / $340.25 / $361.35
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.26 / $177.26 / $229.36
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.96 / $189.96 / $232.60
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 / $132.76 / $181.86
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.18 / $306.23 / $408.30
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.74 / $205.49 / $380.20
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.49 / $425.31 / $566.76
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.42 / $256.79 / $425.31
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.42 / $256.79 / $425.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.36 / $143.90 / $189.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.84 / $169.75 / $255.04