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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Oregon 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 $49 · 10th–90th $33$1070%20%40%10th90th$49Professionalmedian $51 · 10th–90th $33$1050%20%10th90th$51$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
Professional
Modifier
Global
Typical Low
$33.11
Median
$56.23
Typical High
$66.07
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
$48.98
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$72.44
Typical High
$87.10
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$102.33
Typical High
$117.49
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$100.00
Typical High
$107.15
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$48.98
Typical High
$107.15
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$34.67
Typical High
$102.33
Providence
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$56.23
Typical High
$134.90
Providence
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$53.70
Typical High
$107.15
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$93.33
Typical High
$194.98
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$37.15
Typical High
$56.23
United
Setting
Facility
Modifier
Global
Typical Low
$0.08
Median
$51.29
Typical High
$151.36
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$51.29
Typical High
$79.43