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Nationwide rates for HCPCS L0621

Sacroiliac Orthosis Flexible Provides Pelvic- Sacral Support Reduces Motion About The Sacro- Iliac Joint Includes Straps Closures May Include Pendulous Abdomen Design Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.25 / $49.72 / $78.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.46 / $53.18 / $68.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.23 / $74.48 / $115.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.09 / $63.26 / $73.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $67.20 / $77.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $63.34 / $77.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.88 / $124.56 / $124.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.22 / $51.83 / $82.02