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Texas 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 $72 · 10th–90th $38$3310%10%20%10th90th$72Professionalmedian $45 · 10th–90th $38$740%20%40%10th90th$45$0.1$1.0$10.0$100.0$1.0K

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
$38.02 / $39.81 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $42.66 / $72.44
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $72.44
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $3,388.44 / $4,168.69
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $44.67 / $44.67
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $60.26 / $72.44
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $79.43
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 / $67.61
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $331.13
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$537.03 / $537.03 / $537.03
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $72.44 / $141.25
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $41.69 / $79.43
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $81.28
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $38.90 / $38.90
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $72.44 / $141.25
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $67.61
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $57.54 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $63.10 / $74.13
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $72.44 / $72.44