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Rhode Island 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
$34.46 / $53.18 / $72.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$148.29 / $168.25 / $250.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.32 / $79.50 / $83.53
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 / $67.20 / $77.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.56 / $124.56 / $124.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.93 / $60.71 / $101.19