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Colorado 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
$27.38 / $27.38 / $27.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.38 / $43.74 / $65.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.89 / $54.93 / $99.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.26 / $63.26 / $63.26
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 / $84.75
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.46 / $33.46 / $136.15
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.46 / $33.46 / $33.46
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.69 / $61.11 / $96.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.06 / $51.83 / $78.06