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Oregon 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
$33.46 / $56.87 / $399.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $67.20 / $67.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $49.06 / $67.20
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.97 / $68.90 / $89.86
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.81 / $45.14 / $122.45
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.17 / $97.34 / $107.43
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.81 / $77.27 / $108.06
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.81 / $48.89 / $108.06
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.81 / $51.54 / $119.33
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.22 / $56.29 / $113.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.85 / $192.35 / $226.40
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.54 / $36.09 / $110.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.47 / $149.47 / $199.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.54 / $51.83 / $78.81