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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Louisiana 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 $87 · 10th–90th $60$2000%20%10th90th$87Professionalmedian $60 · 10th–90th $39$710%20%10th90th$60$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
$64.57
Median
$64.57
Typical High
$64.57
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$60.26
Typical High
$87.10
BCBS
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$165.96
Typical High
$234.42
BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Christus
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$85.11
United
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$75.86
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$52.48
Typical High
$74.13