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Sacroiliac Orthosis, Flexible, Off-the-Shelf

South Carolina 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 $60 · 10th–90th $42$1290%20%10th90th$60Professionalmedian $51 · 10th–90th $42$830%20%10th90th$51$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
$41.69
Median
$41.69
Typical High
$41.69
Aetna
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$47.86
Typical High
$77.62
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$50.12
Typical High
$50.12
BCBS
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$83.18
Typical High
$93.33
BCBS
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$93.33
Typical High
$117.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$85.11
Medcost
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$56.23
Typical High
$56.23
Medcost
Setting
Facility
Modifier
Global
Typical Low
$41.69
Median
$72.44
Typical High
$151.36
Medcost
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$33.11
Typical High
$33.11
Molina
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$61.66
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$53.70
Typical High
$72.44