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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Connecticut 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 $68 · 10th–90th $49$780%20%10th90th$68Professionalmedian $59 · 10th–90th $37$930%10%20%10th90th$59$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$53.70
Typical High
$93.33
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$75.86
Typical High
$91.20
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$66.07
Typical High
$89.13
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
$48.98
ConnectiCare
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$48.98
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$54.95
Typical High
$100.00
Health New England
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
Health New England
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
United
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$51.29
Typical High
$67.61
United
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$57.54
Typical High
$81.28