go back

Sacroiliac Orthosis, Flexible, Off-the-Shelf

North Carolina 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 $78 · 10th–90th $43$2040%20%10th90th$78Professionalmedian $71 · 10th–90th $40$780%50%10th90th$71$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
$77.62
Median
$77.62
Typical High
$77.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$77.62
Typical High
$77.62
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$50.12
Typical High
$63.10
BCBS
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$131.83
Typical High
$177.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$74.13
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
$75.86
Medcost
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$56.23
Typical High
$69.18
Medcost
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$77.62
Typical High
$141.25
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$74.13
Typical High
$75.86
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$53.70
Typical High
$77.62
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$537.03