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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Arizona 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 $71 · 10th–90th $31$2400%10%10th90th$71Professionalmedian $50 · 10th–90th $28$1070%20%10th90th$50$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
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$61.66
Typical High
$61.66
Aetna
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$47.86
Typical High
$66.07
BCBS
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$131.83
Typical High
$251.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$123.03
Typical High
$245.47
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
$67.61
Medica
Setting
Facility
Modifier
Global
Typical Low
$30.90
Median
$69.18
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$51.29
Typical High
$524.81
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$57.54
Typical High
$72.44
United
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$51.29
Typical High
$77.62