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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Colorado 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 $50 · 10th–90th $28$1260%10%10th90th$50Professionalmedian $48 · 10th–90th $28$660%10%20%10th90th$48$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
$27.54
Median
$27.54
Typical High
$47.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$38.90
Typical High
$63.10
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$60.26
Typical High
$107.15
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$63.10
Typical High
$64.57
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
$77.62
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$56.23
Typical High
$134.90
Denver HMP
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$33.11
Typical High
$33.11
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$50.12
Typical High
$173.78
Select Health
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$93.33
Typical High
$104.71
Select Health
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$63.10
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$51.29
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$51.29
Typical High
$77.62