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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Hawaii 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 $65 · 10th–90th $51$1150%20%40%10th90th$65Professionalmedian $129 · 10th–90th $38$1350%50%10th90th$129$20.0$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
$63.10
Typical High
$63.10
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$77.62
Typical High
$114.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$117.49
Typical High
$158.49
HMSA
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$134.90
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$128.82
Typical High
$177.83
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$52.48
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$19.05
Median
$87.10
Typical High
$181.97