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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Alaska 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.

How much does Sacroiliac Orthosis, Flexible, Off-the-Shelf cost?

$63.10

Typical negotiated rate. In Alaska, July 2026.

Insurers have agreed to pay about $63.10 for this service. The price depends on where it is billed: about $63.10 from a physician practice, and about $33.88 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$63.10$46.77 to $117
FacilityA hospital or hospital-owned outpatient department$33.88$33.11 to $115

How much rates vary

Facilitymedian $34 · 10th to 90th $33 to $117Professionalmedian $63 · 10th to 90th $37 to $129
$50$100$200facility $34professional $63

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$239.88
Typical High
$239.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$53.70
Typical High
$104.71
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
$138.04
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$33.88
Typical High
$117.49
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$117.49
Typical High
$181.97
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$117.49
Typical High
$123.03
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$117.49
Typical High
$125.89
Providence
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$33.11
Typical High
$104.71
Providence
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$60.26
Typical High
$100.00
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$54.95
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$102.33
Typical High
$338.84

Where Alaska sits

The same service costs 4.2 times more in Hawaii than in Washington, DC. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Alaska· 19th of 51

$63.10

HI $129DC $30.90

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.