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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Wyoming 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 $51 · 10th–90th $48$580%20%10th90th$51Professionalmedian $48 · 10th–90th $25$630%20%40%10th90th$48$20.0$50.0

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
$24.55
Median
$27.54
Typical High
$63.10
BCBS
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
BCBS
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
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
$67.61
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$51.29
Typical High
$57.54
United
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$51.29
Typical High
$79.43