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Indiana 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
$36.79 / $36.79 / $63.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.76 / $36.79 / $57.77
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.89 / $66.89 / $97.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.95 / $56.59 / $63.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.41 / $63.26 / $85.22
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.75 / $74.48 / $94.85
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.75 / $69.55 / $85.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.23 / $67.20 / $77.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $67.20 / $85.88
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 / $74.81