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Pennsylvania 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 $33$1290%20%40%10th90th$107Professionalmedian $47 · 10th–90th $33$790%20%10th90th$47$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
$33.11 / $128.82 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $44.67 / $79.43
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $69.18
AmeriHealth
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $61.66
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $66.07
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $72.44
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $87.10 / $128.82
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $67.61
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $46.77 / $67.61
Independence Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $48.98
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $33.11 / $33.11
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $44.67 / $74.13
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $38.90 / $162.18
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $72.44 / $74.13
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $74.13 / $104.71
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $128.82 / $144.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $51.29 / $91.20