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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Maryland 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 $60 · 10th–90th $39$680%20%10th90th$60Professionalmedian $44 · 10th–90th $31$780%20%10th90th$44$20.0$50.0$100.0$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
Professional
Modifier
Global
Typical Low
$30.90
Median
$36.31
Typical High
$72.44
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
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
$67.61
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$67.61
Typical High
$104.71
United
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$51.29
Typical High
$67.61
United
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$52.48
Typical High
$83.18
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$61.66
Typical High
$61.66