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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Nebraska 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 $79 · 10th–90th $51$2400%10%10th90th$79Professionalmedian $43 · 10th–90th $40$740%50%10th90th$43$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
$57.54
Median
$79.43
Typical High
$79.43
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$42.66
Typical High
$63.10
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$81.28
Typical High
$190.55
BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$70.79
Typical High
$70.79
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$77.62
Typical High
$117.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$109.65
Typical High
$263.03
Medica
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$100.00
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$67.61
Typical High
$109.65
Midlands
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$288.40
Midlands
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Midlands
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$263.03
Typical High
$288.40
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$75.86
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$60.26
Typical High
$89.13