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West 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
$175.78 / $175.78 / $175.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.97 / $168.23 / $188.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.16 / $425.31 / $595.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$205.03 / $238.18 / $351.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $181.86 / $380.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.76 / $181.86 / $1,596.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$143.90 / $143.90 / $143.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.70 / $169.75 / $282.91