go back

Sacroiliac Orthosis, Flexible, Off-the-Shelf

Utah 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 $48 · 10th–90th $33$510%50%10th90th$48Professionalmedian $50 · 10th–90th $22$1410%10%20%10th90th$50$20.0$50.0$100.0

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
$33.11
Median
$47.86
Typical High
$47.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$63.10
Typical High
$141.25
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
$69.18
Molina
Setting
Professional
Modifier
Global
Typical Low
$21.88
Median
$26.92
Typical High
$104.71
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$48.98
Typical High
$66.07
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$35.48
Typical High
$70.79
Select Health
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$50.12
Typical High
$50.12
Select Health
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$50.12
Typical High
$104.71
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$50.12
Typical High
$74.13
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$51.29
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$48.98
Typical High
$74.13