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Virginia 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 $76 · 10th–90th $48$1150%20%40%10th90th$76Professionalmedian $58 · 10th–90th $37$1050%20%10th90th$58$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
$30.90 / $51.29 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $51.29 / $77.62
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $81.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $131.83
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $67.61 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $64.57
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $79.43 / $117.49
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $69.18 / $104.71
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $67.61 / $114.82
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $67.61 / $95.50
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $79.43 / $309.03
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $79.43 / $309.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $51.29 / $128.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $51.29 / $83.18