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Nebraska 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 $79 · 10th–90th $51$2450%10%10th90th$79Professionalmedian $60 · 10th–90th $33$1910%10%10th90th$60$50.0$100.0$200.0$500.0

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
$57.54 / $79.43 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $57.54 / $251.19
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $81.28 / $190.55
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $70.79 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $77.62 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $107.15 / $229.09
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $100.00 / $323.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $67.61 / $109.65
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $281.84
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
$158.49 / $263.03 / $281.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $61.66 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $63.10 / $102.33