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Connecticut 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
$59.15 / $59.15 / $59.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.15 / $59.14 / $62.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.73 / $74.48 / $85.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.26 / $63.26 / $66.29
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 / $49.06 / $67.20
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.42 / $48.42 / $48.42
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.48 / $48.42 / $63.32
Health New England
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.02 / $74.02 / $74.02
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.02 / $74.02 / $74.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.04 / $60.71 / $84.18