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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Mississippi 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 $81 · 10th–90th $44$1290%20%40%10th90th$81Professionalmedian $51 · 10th–90th $39$710%10%20%10th90th$51$50.0$100.0

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
$67.61
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$51.29
Typical High
$70.79
BCBS
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
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
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$61.66
United
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$69.18
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$51.29
Typical High
$75.86