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Wyoming 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
$162.97 / $162.97 / $254.85
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.22 / $284.22 / $284.22
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.22 / $284.22 / $284.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.86 / $181.86 / $382.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.76 / $132.76 / $181.86
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.64 / $143.90 / $143.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.22 / $145.19 / $161.19