go back

Oklahoma 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
$40.92 / $40.92 / $78.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.40 / $40.92 / $62.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.78 / $75.78 / $75.78
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 / $77.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.46 / $63.91 / $324.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.54 / $53.80 / $99.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.88 / $105.88 / $105.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.54 / $51.83 / $74.34