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New Jersey 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
$37.10 / $37.10 / $37.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.06 / $42.65 / $62.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.36 / $67.20 / $77.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $49.06 / $83.87
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.13 / $71.90 / $99.56
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.36 / $90.61 / $90.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.88 / $124.56 / $149.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.84 / $54.37 / $91.73