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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Vermont 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 $65 · 10th–90th $39$780%20%40%10th90th$65Professionalmedian $59 · 10th–90th $51$790%20%10th90th$59$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$58.88
Typical High
$69.18
BCBS
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
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
$87.10
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$95.50
Typical High
$95.50
United
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$51.29
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$79.43
Typical High
$177.83