go back

Mississippi 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
$49.85 / $49.85 / $79.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.46 / $56.87 / $79.45
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.26 / $91.26 / $91.26
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.16 / $81.16 / $81.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.16 / $81.16 / $81.16
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 / $49.06 / $77.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.88 / $124.56 / $149.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.54 / $51.28 / $80.45