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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Kentucky 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 $55 · 10th–90th $44$1050%20%40%10th90th$55Professionalmedian $44 · 10th–90th $30$660%10%20%10th90th$44$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
$43.65
Median
$43.65
Typical High
$44.67
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$43.65
Typical High
$66.07
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$69.18
Typical High
$81.28
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$75.86
Typical High
$81.28
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$63.10
CareSource
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$100.00
Typical High
$131.83
CareSource
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$93.33
Typical High
$120.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$104.71
Typical High
$104.71
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$74.13
Typical High
$346.74
Molina
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$75.86
Typical High
$97.72
United
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$51.29
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$51.29
Typical High
$75.86