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Arizona 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
$28.10 / $56.82 / $77.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.78 / $111.18 / $201.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.94 / $102.58 / $139.77
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 / $84.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.46 / $70.23 / $324.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.93 / $51.83 / $78.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.79 / $51.83 / $78.06