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Vermont 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
$34.46 / $59.40 / $68.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.72 / $70.72 / $158.25
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 / $86.48
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $67.20 / $77.70
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $71.64 / $86.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.47 / $72.09 / $140.71