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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Indiana 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 $37$980%50%10th90th$65Professionalmedian $49 · 10th–90th $34$850%20%10th90th$49$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
$37.15
Median
$37.15
Typical High
$37.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$40.74
Typical High
$74.13
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$69.18
Typical High
$97.72
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$64.57
Typical High
$109.65
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$63.10
Typical High
$97.72
CareSource
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$97.72
Typical High
$112.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$67.61
Typical High
$91.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$85.11
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$52.48
Typical High
$72.44
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$51.29
Typical High
$75.86