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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Kansas 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 $76 · 10th–90th $33$1450%20%10th90th$76Professionalmedian $115 · 10th–90th $46$1150%50%10th$115$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
$70.79
Median
$70.79
Typical High
$74.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$48.98
Typical High
$77.62
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
BCBS
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$141.25
Typical High
$151.36
BCBS
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$114.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$70.79
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$85.11
Medica
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$67.61
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$67.61
Typical High
$524.81
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$66.07
Typical High
$85.11
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$64.57
Typical High
$91.20