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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Florida 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 $56 · 10th–90th $46$1740%20%10th90th$56Professionalmedian $51 · 10th–90th $39$780%20%10th90th$51$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
$45.71
Median
$52.48
Typical High
$56.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$51.29
Typical High
$77.62
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$177.83
AvMed
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
AvMed
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$75.86
Typical High
$83.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$104.71
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$24.55
Median
$48.98
Typical High
$77.62
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$77.62
Typical High
$89.13
United
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$54.95
Typical High
$81.28
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$52.48
Typical High
$74.13
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$77.62
Typical High
$77.62