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Massachusetts 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
$53.18 / $53.18 / $76.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.46 / $53.18 / $68.54
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.31 / $265.27 / $324.51
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.47 / $67.62 / $87.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.88 / $157.15 / $202.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.72 / $82.31 / $82.31
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 / $63.34 / $84.75
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.53 / $98.53 / $103.46
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
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.93 / $324.51 / $324.51
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.18 / $60.71 / $94.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.56 / $124.56 / $124.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $60.71 / $91.73