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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Arkansas 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 October 2026.

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

$64.57

Typical negotiated rate. In Arkansas, October 2026.

Insurers have agreed to pay about $64.57 for this service. The price depends on where it is billed: about $64.57 from a physician practice, and about $67.61 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$64.57$56.23 to $85.11
FacilityA hospital or hospital-owned outpatient department$67.61$67.61 to $107

How much rates vary

Facilitymedian $68 · 10th to 90th $63 to $129Professionalmedian $65 · 10th to 90th $49 to $85
$20$50$100facility $68professional $65

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Aetna
Setting
Professional
Modifier
None
Typical Low
$42.66
Median
$63.10
Typical High
$63.10
Ambetter
Setting
Professional
Modifier
None
Typical Low
$50.12
Median
$75.86
Typical High
$75.86
BCBS Arkansas
Setting
Professional
Modifier
None
Typical Low
$64.57
Median
$70.79
Typical High
$85.11
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$77.62
Cigna
Setting
Professional
Modifier
None
Typical Low
$37.15
Median
$48.98
Typical High
$67.61
Qualchoice
Setting
Professional
Modifier
None
Typical Low
$57.54
Median
$87.10
Typical High
$87.10
United
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$128.82
Typical High
$128.82
United
Setting
Professional
Modifier
None
Typical Low
$35.48
Median
$52.48
Typical High
$75.86
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Qualchoice
Setting
Professional
Modifier
KX · Policy requirements met
Typical Low
$74.13
Median
$74.13
Typical High
$74.13

Where Arkansas sits

The same service costs 3.6 times more in Hawaii than in Utah. 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.

Arkansas· 19th of 51

$64.57

HI $129UT $35.48

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.