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Maryland 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
$31.09 / $41.57 / $62.39
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.99 / $57.99 / $57.99
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.75 / $65.36 / $98.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.94 / $51.83 / $82.02
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.75 / $62.24 / $62.24