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South Carolina 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
$41.57 / $41.57 / $41.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.46 / $41.57 / $77.89
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $50.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $81.95 / $109.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $67.20 / $74.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $64.95 / $77.70
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.57 / $72.17 / $135.90
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.78 / $75.78 / $75.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.99 / $72.99 / $72.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.56 / $124.56 / $124.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.93 / $51.83 / $67.73