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Idaho 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 $69 · 10th–90th $43$1260%10%20%10th90th$69Professionalmedian $56 · 10th–90th $33$1170%10%10th90th$56$20.0$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
$47.86 / $47.86 / $91.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $56.23 / $66.07
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $107.15 / $154.88
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $117.49 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $67.61
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $72.44 / $114.82
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $47.86 / $64.57
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $91.20
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $47.86 / $70.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $35.48 / $75.86
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $50.12 / $107.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $56.23 / $64.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $51.29 / $79.43