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Kansas 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
$74.31 / $101.85 / $101.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.46 / $48.70 / $74.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$135.10 / $142.21 / $151.27
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.35 / $128.35 / $128.35
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 / $67.20 / $105.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.46 / $73.03 / $324.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.54 / $65.37 / $136.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.88 / $105.88 / $124.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.10 / $64.59 / $90.57