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Idaho 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
$48.13 / $91.70 / $91.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.39 / $62.39 / $65.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $67.20 / $86.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $49.06 / $71.64
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.81 / $48.89 / $95.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.53 / $44.00 / $48.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $77.72 / $92.38
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.47 / $47.47 / $108.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.22 / $35.69 / $51.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.92 / $51.83 / $90.97