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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Massachusetts 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 $148 · 10th–90th $54$2340%20%10th90th$148Professionalmedian $65 · 10th–90th $43$1000%20%40%10th90th$65$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$53.70
Median
$53.70
Typical High
$120.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$37.15
Median
$53.70
Typical High
$125.89
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$83.18
Typical High
$331.13
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$72.44
Typical High
$109.65
BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$158.49
Typical High
$208.93
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
$77.62
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$100.00
Health New England
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
Health New England
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$83.18
Typical High
$331.13
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$72.44
Typical High
$109.65
United
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$64.57
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$64.57
Typical High
$85.11