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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Tennessee 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 $74 · 10th–90th $46$3310%20%10th90th$74Professionalmedian $46 · 10th–90th $40$740%20%40%10th90th$46$0.1$0.5$2.0$10.0$50.0$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
$45.71
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$43.65
Typical High
$72.44
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$83.18
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
$67.61
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$537.03
Typical High
$537.03
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$57.54
Typical High
$77.62
United
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$51.29
Typical High
$72.44