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Sacroiliac Orthosis, Flexible, Off-the-Shelf

New Jersey 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 $37 · 10th–90th $37$680%50%90th$37Professionalmedian $49 · 10th–90th $33$910%10%10th90th$49$20.0$50.0$100.0$200.0

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
$37.15
Median
$37.15
Typical High
$37.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$42.66
Typical High
$63.10
Cigna
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$67.61
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$70.79
Typical High
$97.72
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$91.20
Typical High
$91.20
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$67.61
Typical High
$93.33
United
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$54.95
Typical High
$81.28