go back

Texas 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
$38.65 / $40.15 / $50.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.79 / $40.15 / $64.56
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.13 / $70.13 / $70.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,456.92 / $5,821.21 / $8,577.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.86 / $44.86 / $58.09
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.17 / $59.70 / $70.23
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.23 / $70.23 / $70.23
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 / $67.98
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.85 / $324.51 / $324.51
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.47 / $539.41 / $539.41
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.46 / $70.23 / $86.52
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.81 / $63.22 / $88.08
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.00 / $39.00 / $39.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.46 / $67.20 / $84.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $49.06 / $71.64
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.88 / $105.88 / $124.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.19 / $62.46 / $74.34
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.24 / $63.26 / $70.23