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Louisiana 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
$60.81 / $64.56 / $86.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.76 / $62.39 / $70.17
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.51 / $93.51 / $126.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.94 / $167.31 / $235.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.11 / $70.77 / $70.77
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $67.20 / $77.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.88 / $124.56 / $124.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.54 / $51.83 / $79.87