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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Iowa 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 $93 · 10th–90th $51$2630%10%20%10th90th$93Professionalmedian $63 · 10th–90th $34$1200%20%10th90th$63$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
$42.66
Median
$56.23
Typical High
$93.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$56.23
Typical High
$79.43
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$117.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$107.15
Typical High
$125.89
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$81.28
Typical High
$120.23
Medica
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$134.90
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$77.62
Typical High
$194.98
Midlands
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$123.03
Typical High
$138.04
Midlands
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Midlands
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$229.09
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$75.86
Typical High
$204.17
United
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$67.61
Typical High
$120.23
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$104.71
Typical High
$104.71