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Alaska 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
$223.87 / $223.87 / $239.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.39 / $103.58 / $136.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $67.20 / $67.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $67.20 / $71.64
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.46 / $33.46 / $33.46
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.17 / $113.88 / $179.81
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.46 / $33.46 / $67.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $70.76 / $100.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.50 / $129.59 / $169.04