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Missouri rates for HCPCS L0621

Sacroiliac orthosis (SO), flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.71 / $45.71 / $52.48
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.11 / $50.12 / $141.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $69.18 / $81.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $263.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $63.10 / $125.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $44.67 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $67.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $72.44 / $323.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $67.61 / $524.81
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $58.88 / $83.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $61.66 / $87.10