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North Dakota 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
$93.51 / $93.51 / $93.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.87 / $62.39 / $93.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.28 / $80.73 / $82.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.75 / $85.60 / $107.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.15 / $73.03 / $324.51
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.19 / $57.54 / $102.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.47 / $149.47 / $149.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.37 / $51.83 / $102.41