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Utah 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
$33.46 / $48.13 / $48.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.46 / $38.65 / $399.64
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
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.80 / $26.62 / $35.93
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.47 / $47.47 / $66.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.22 / $42.53 / $73.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.58 / $51.37 / $51.83