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Wyoming 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
$27.38 / $27.38 / $63.74
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.47 / $47.47 / $47.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.47 / $47.47 / $47.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.20 / $67.20 / $115.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $49.06 / $67.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.84 / $51.83 / $57.54