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Kentucky 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
$43.17 / $44.77 / $44.77
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.76 / $41.44 / $62.39
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.89 / $66.89 / $78.76
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.37 / $74.48 / $78.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.41 / $30.41 / $63.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.87 / $100.56 / $122.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.32 / $89.39 / $122.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $67.20 / $96.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $67.20 / $334.22
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.17 / $72.17 / $90.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.10 / $51.83 / $70.77