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Arkansas 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
$62.55 / $62.55 / $62.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.21 / $62.55 / $62.55
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.81 / $74.81 / $74.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.93 / $84.62 / $94.02
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.48 / $74.48 / $74.48
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.48 / $74.48 / $74.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.59 / $67.20 / $77.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $67.20 / $77.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.88 / $105.88 / $124.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.54 / $51.37 / $69.87