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Florida 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
$44.76 / $49.60 / $56.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.09 / $49.60 / $77.89
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 / $67.20
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.33 / $66.33 / $66.33
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.69 / $72.17 / $82.30
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.33 / $77.44 / $85.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.56 / $124.56 / $124.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.19 / $52.76 / $74.34
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.48 / $77.44 / $77.44