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Sacroiliac Orthosis, Flexible, Off-the-Shelf

North Dakota 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 $93 · 10th–90th $56$1320%50%10th90th$93Professionalmedian $69 · 10th–90th $56$930%20%10th90th$69$20.0$50.0$100.0$200.0$500.0

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
$56.23
Median
$93.33
Typical High
$93.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$63.10
Typical High
$125.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$79.43
Typical High
$89.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$85.11
Typical High
$107.15
Medica
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$93.33
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$51.29
Typical High
$104.71
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$72.44
Typical High
$104.71