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Sacroiliac Orthosis, Flexible, Off-the-Shelf

New Mexico 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 $56 · 10th–90th $33$1070%10%10th90th$56Professionalmedian $56 · 10th–90th $28$1050%20%10th90th$56$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
$42.66
Median
$42.66
Typical High
$42.66
Aetna
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$63.10
Typical High
$141.25
BCBS
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$56.23
Typical High
$77.62
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$67.61
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$107.15
Molina
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$102.33
Typical High
$154.88
Providence
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$56.23
Typical High
$100.00
Providence
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
United
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$56.23
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$51.29
Typical High
$77.62