go back

Sacroiliac Orthosis, Flexible, Off-the-Shelf

New York 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 $68 · 10th–90th $39$1230%20%10th90th$68Professionalmedian $63 · 10th–90th $39$1230%20%10th90th$63$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$47.86
Typical High
$89.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$47.86
Typical High
$75.86
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$134.90
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$169.82
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$81.28
Typical High
$81.28
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$69.18
Typical High
$104.71
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$77.62
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$109.65
Typical High
$257.04
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$70.79
Typical High
$128.82
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$77.62
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$67.61
Typical High
$74.13
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$63.10
Typical High
$102.33
United
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$60.26
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$61.66
Typical High
$112.20
Univera
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$77.62
Univera
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$67.61
Typical High
$74.13