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Utah 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 $48 · 10th–90th $33–$490%50%10th90th$48Professionalmedian $50 · 10th–90th $27–$1410%10%10th90th$50$20.0$50.0$100.0$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
$33.11 / $47.86 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $56.23 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $69.18
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $26.92 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $48.98 / $66.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $35.48 / $72.44
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $50.12 / $104.71
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $50.12 / $74.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $51.29 / $54.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $50.12 / $74.13