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New York 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 $74 · 10th–90th $47$1350%20%40%10th90th$74Professionalmedian $63 · 10th–90th $37$1290%20%10th90th$63$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$37.15 / $87.10 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $48.98 / $97.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $134.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $169.82
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $81.28 / $81.28
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $81.28
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $77.62 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $109.65
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $109.65 / $257.04
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $70.79 / $128.82
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $74.13 / $77.62
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $67.61 / $74.13
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $63.10 / $87.10
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $60.26 / $186.21
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $61.66 / $112.20
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $77.62
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $67.61 / $74.13