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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Montana 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 $68 · 10th–90th $48$1450%20%10th90th$68Professionalmedian $63 · 10th–90th $33$1070%20%10th90th$63$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
Professional
Modifier
Global
Typical Low
$24.55
Median
$63.10
Typical High
$141.25
BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$69,183.10
Typical High
$91,201.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$107.15
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$107.15
Typical High
$107.15
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$56.23
Typical High
$107.15
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$56.23
Typical High
$107.15
Providence
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$85.11
Typical High
$131.83
Providence
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$79.43
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$54.95
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$51.29
Typical High
$79.43