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Washington, DC 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
$31.09 / $31.09 / $31.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.09 / $31.09 / $31.09
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $57.99 / $57.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $49.06 / $49.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.48 / $42.48 / $128.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.47 / $149.47 / $149.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.54 / $51.83 / $77.87