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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Alaska 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 $34 · 10th–90th $33$1170%50%10th90th$34Professionalmedian $63 · 10th–90th $37$1290%10%10th90th$63$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
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$239.88
Typical High
$239.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$53.70
Typical High
$104.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$67.61
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$138.04
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$33.88
Typical High
$117.49
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$117.49
Typical High
$181.97
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$117.49
Typical High
$123.03
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$117.49
Typical High
$125.89
Providence
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$33.11
Typical High
$104.71
Providence
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$60.26
Typical High
$100.00
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$54.95
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$102.33
Typical High
$338.84