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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Virginia 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 $76 · 10th–90th $51$1150%20%40%10th90th$76Professionalmedian $55 · 10th–90th $35$1020%20%10th90th$55$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
Facility
Modifier
Global
Typical Low
$30.90
Median
$51.29
Typical High
$51.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$51.29
Typical High
$63.10
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$81.28
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$131.83
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$43.65
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
$50.12
Median
$79.43
Typical High
$117.49
Medcost
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$69.18
Typical High
$104.71
Medcost
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$67.61
Typical High
$114.82
Medcost
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$67.61
Typical High
$95.50
Sentara
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$79.43
Typical High
$309.03
Sentara
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$79.43
Typical High
$309.03
United
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$51.29
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$51.29
Typical High
$83.18