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Maine 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
$73.87 / $73.87 / $192.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.18 / $73.87 / $73.87
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.25 / $85.83 / $159.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.26 / $66.29 / $66.29
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $67.20 / $67.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $49.06 / $67.20
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.53 / $98.53 / $98.53
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.56 / $192.56 / $192.56
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.39 / $73.87 / $73.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.47 / $63.90 / $168.53