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New Hampshire 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
$68.54 / $68.54 / $82.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.06 / $53.18 / $68.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.48 / $74.48 / $88.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.26 / $63.26 / $66.29
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 / $71.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.53 / $98.53 / $304.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.28 / $60.71 / $67.89
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.23 / $88.25 / $112.32