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Vermont 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
$120.23 / $181.97 / $218.78
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 / $186.21
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $302.00 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $144.54 / $181.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.83 / $229.09 / $812.83