go back

Arizona rates for HCPCS L0621

Sacroiliac orthosis (SO), flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.10 / $56.82 / $77.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.78 / $111.18 / $201.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.94 / $102.58 / $139.77
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 / $49.06 / $84.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.46 / $70.23 / $324.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.93 / $51.83 / $78.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.79 / $51.83 / $78.06