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Minnesota 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 $107 · 10th–90th $68–$5370%20%10th90th$107Professionalmedian $85 · 10th–90th $42–$890%50%10th90th$85$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 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $56.23 / $72.44
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $89.13 / $120.23
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $89.13 / $89.13
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $275.42 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $97.72 / $107.15
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $269.15 / $537.03
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $85.11 / $114.82
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $72.44 / $323.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $51.29 / $104.71
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.83 / $51.29 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $60.26 / $112.20