go back

Sacroiliac Orthosis, Flexible, Off-the-Shelf

Arkansas 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 $398,107 · 10th–90th $63$891,2510%10%20%10th90th$398,107Professionalmedian $52 · 10th–90th $33$740%20%40%10th90th$52$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
$63.10
Median
$63.10
Typical High
$63.10
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$60.26
Typical High
$74.13
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$50.12
Typical High
$75.86
BCBS
Setting
Facility
Modifier
Global
Typical Low
$218,776.16
Median
$524,807.46
Typical High
$954,992.59
BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$85.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$67.61
Typical High
$117.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$48.98
Typical High
$67.61
Qualchoice
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$87.10
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$54.95
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$51.29
Typical High
$75.86