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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Idaho 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 $72 · 10th–90th $43$1290%10%10th90th$72Professionalmedian $63 · 10th–90th $31$1170%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
$47.86
Median
$89.13
Typical High
$91.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$63.10
Typical High
$66.07
BCBS
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$107.15
Typical High
$154.88
BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$117.49
Typical High
$117.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$87.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$72.44
Typical High
$114.82
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$47.86
Typical High
$64.57
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$91.20
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$70.79
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$35.48
Typical High
$75.86
Select Health
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$51.29
Typical High
$165.96
Select Health
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$69.18
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$0.08
Median
$56.23
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$51.29
Typical High
$79.43