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Washington 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 $79 · 10th–90th $32$1700%10%20%10th90th$79Professionalmedian $48 · 10th–90th $29$1120%5%10%10th90th$48$1.0$5.0$20.0$100.0$500.0

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
$41.69 / $87.10 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $45.71 / $79.43
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $31.62 / $112.20
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $30.20 / $91.20
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $97.72 / $251.19
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $93.33 / $169.82
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $104.71 / $114.82
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $48.98 / $107.15
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$29.51 / $33.11 / $102.33
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $51.29 / $83.18
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $53.70
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $31.62 / $56.23
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $33.88 / $91.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $151.36 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $51.29 / $87.10
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$23.44 / $28.84 / $91.20