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Minnesota 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
$56.87 / $56.87 / $89.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.46 / $56.87 / $64.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.42 / $87.64 / $121.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.34 / $84.73 / $89.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $224.50 / $623.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.75 / $89.84 / $107.63
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$133.28 / $215.39 / $490.96
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.75 / $84.75 / $86.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.46 / $73.03 / $324.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.54 / $57.87 / $105.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.88 / $124.56 / $149.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.54 / $51.83 / $105.30