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North Carolina 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
$77.89 / $77.89 / $163.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.46 / $77.89 / $77.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $68.45 / $68.45
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.40 / $131.94 / $162.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.54 / $68.45 / $75.30
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 / $84.75
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.46 / $77.89 / $112.90
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.78 / $75.78 / $75.78
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.40 / $78.40 / $201.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.94 / $53.41 / $79.19
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.71 / $324.51 / $324.51
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.41 / $539.41 / $539.41