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Missouri 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
$46.99 / $48.70 / $101.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.21 / $48.70 / $74.31
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.76 / $78.76 / $125.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.03 / $76.68 / $337.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.41 / $63.26 / $102.78
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 / $74.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.74 / $77.61 / $324.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.19 / $67.62 / $164.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.56 / $124.56 / $149.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.19 / $64.79 / $90.57