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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Washington, DC 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 $31 · 10th–90th $31$1510%50%90th$31Professionalmedian $31 · 10th–90th $31$590%50%90th$31$50.0$100.0

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
Facility
Modifier
Global
Typical Low
$30.90
Median
$30.90
Typical High
$30.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$30.90
Typical High
$58.88
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
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
$72.44
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$57.54
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$51.29
Typical High
$70.79