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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Nationwide 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

Rates data updated July 2026.

Facilitymedian $65 · 10th–90th $40$2040%20%10th90th$65Professionalmedian $56 · 10th–90th $35$980%20%10th90th$56$0.1$2.0$50.0$1.0K$20.0K$500.0K

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
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$51.29
Typical High
$93.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$48.98
Typical High
$77.62
BCBS
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$64.57
Typical High
$151.36
BCBS
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$63.10
Typical High
$112.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$70.79
Typical High
$281.84
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$60.26
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$53.70
Typical High
$87.10