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Maine 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 $93 · 10th–90th $68–$1910%20%40%10th90th$93Professionalmedian $62 · 10th–90th $37–$830%20%10th90th$62$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $51.29 / $138.04
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $89.13 / $102.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $77.62
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $56.23 / $74.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $51.29 / $51.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $64.57 / $100.00