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Sacroiliac Orthosis, Flexible, Off-the-Shelf

California 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 $60 · 10th–90th $48$1510%20%10th90th$60Professionalmedian $63 · 10th–90th $37$1410%20%10th90th$63$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

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
$141.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$63.10
Typical High
$141.25
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$57.54
Typical High
$72.44
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$60.26
Typical High
$151.36
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$63.10
Typical High
$69.18
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$218.78
Typical High
$338.84
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$100.00
Typical High
$144.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$74.13
Typical High
$89.13
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$97.72
Typical High
$177.83
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$537.03
Molina
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$102.33
Optum
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$70.79
Providence
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$44.67
Typical High
$123.03
Providence
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$263.03
Median
$263.03
Typical High
$263.03
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$75.86
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$8.51
Median
$51.29
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$53.70
Typical High
$109.65