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Montana 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
Professional
Modifier
Low / Median / High Price
$24.39 / $62.39 / $399.64
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.92 / $98.92 / $98.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $106.59 / $106.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.20 / $106.59 / $106.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.89 / $73.00 / $106.59
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.37 / $67.20 / $106.59
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.84 / $51.83 / $56.14