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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Rhode Island 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 $170 · 10th–90th $65$2510%20%10th90th$170Professionalmedian $59 · 10th–90th $43$790%10%20%10th90th$59$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$58.88
Typical High
$72.44
BCBS
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$173.78
Typical High
$251.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$79.43
Typical High
$114.82
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
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$64.57
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$64.57
Typical High
$97.72