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Vermont 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
Professional
Modifier
Low / Median / High Price
$189.37 / $189.37 / $218.51
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 / $241.67
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $181.86 / $181.86
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.76 / $181.86 / $241.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.90 / $143.90 / $181.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.06 / $229.87 / $448.62