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Wisconsin 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 $65 · 10th–90th $63$1290%50%10th90th$65Professionalmedian $60 · 10th–90th $37$980%10%20%10th90th$60$0.1$0.5$2.0$10.0$50.0$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
$37.15 / $37.15 / $37.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $41.69 / $91.20
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $107.15
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $70.79
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $245.47 / $363.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $107.15 / $120.23
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $63.10 / $93.33
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $120.23 / $162.18
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $72.44 / $323.59
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $61.66 / $114.82
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $64.57 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $165.96 / $165.96
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $85.11 / $158.49
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $75.86 / $138.04
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $128.82 / $323.59
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $97.72 / $537.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $57.54 / $97.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $51.29 / $85.11