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Arizona 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 $71 · 10th–90th $31–$2400%10%10th90th$71Professionalmedian $51 · 10th–90th $35–$1120%20%10th90th$51$0.1$0.5$2.0$10.0$50.0$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
$61.66 / $61.66 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $46.77 / $93.33
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $128.82 / $239.88
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $117.49 / $223.87
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 / $67.61
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $69.18 / $323.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $524.81
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $57.54 / $57.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $51.29 / $77.62