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Iowa 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 $95 · 10th–90th $56$3020%20%10th90th$95Professionalmedian $56 · 10th–90th $37$1320%10%20%10th90th$56$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
$56.23 / $56.23 / $93.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $46.77 / $93.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $107.15 / $123.03
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $81.28 / $120.23
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $134.90 / $323.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $77.62 / $194.98
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $120.23 / $138.04
Midlands
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $117.49
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $229.09 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $87.10 / $251.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $67.61 / $114.82
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $102.33 / $102.33