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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Nevada 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 $21 · 10th–90th $21$600%50%90th$21Professionalmedian $45 · 10th–90th $21$870%10%10th90th$45$1.0$2.0$5.0$10.0$20.0$50.0$100.0

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
$21.38
Median
$21.38
Typical High
$21.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$33.88
Typical High
$141.25
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$33.88
Typical High
$35.48
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Cigna
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$67.61
Typical High
$114.82
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$77.62
Hometown Health
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$33.88
Typical High
$81.28
Select Health
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$33.88
Typical High
$33.88
Select Health
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$30.20
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$51.29
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$51.29
Typical High
$79.43