go back

West Virginia 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
$45.42 / $45.42 / $45.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.68 / $45.42 / $62.39
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.42 / $94.85 / $130.36
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.42 / $52.14 / $89.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $77.70 / $96.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $67.20 / $334.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.88 / $105.88 / $105.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.44 / $51.83 / $86.38