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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Missouri 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 $47$1620%20%10th90th$76Professionalmedian $63 · 10th–90th $44$1410%20%10th90th$63$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
$46.77
Median
$46.77
Typical High
$53.70
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$50.12
Typical High
$141.25
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$263.03
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$63.10
Typical High
$125.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$75.86
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$100.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
Medica
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$72.44
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$67.61
Typical High
$524.81
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$60.26
Typical High
$85.11
United
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$61.66
Typical High
$87.10