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Alaska rates for HCPCS L0621

Sacroiliac orthosis (SO), flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf

Facilitymedian $34 · 10th–90th $33–$1170%50%10th90th$34Professionalmedian $62 · 10th–90th $37–$1260%10%10th90th$62$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $56.23 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $138.04
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $51.29 / $117.49
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $117.49 / $181.97
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $117.49 / $123.03
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $117.49 / $125.89
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $33.11 / $104.71
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $60.26 / $100.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $54.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $102.33 / $338.84