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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Arizona 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?

$51.29

Typical negotiated rate. In Arizona, October 2026.

Insurers have agreed to pay about $51.29 for this service. The price depends on where it is billed: about $51.29 from a physician practice, and about $120 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$51.29$47.86 to $102
FacilityA hospital or hospital-owned outpatient department$120$67.61 to $200

How much rates vary

Facilitymedian $120 · 10th to 90th $31 to $324Professionalmedian $51 · 10th to 90th $28 to $525
$20$50$100$200$500facility $120professional $51

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

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$28.18
Median
$28.18
Typical High
$43.65
BCBS Arizona
Setting
Facility
Modifier
None
Typical Low
$30.90
Median
$138.04
Typical High
$208.93
BCBS Arizona
Setting
Professional
Modifier
None
Typical Low
$89.13
Median
$102.33
Typical High
$186.21
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$67.61
Cigna
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
Medica
Setting
Facility
Modifier
None
Typical Low
$30.90
Median
$102.33
Typical High
$323.59
Medica
Setting
Professional
Modifier
None
Typical Low
$46.77
Median
$56.23
Typical High
$524.81
United
Setting
Professional
Modifier
None
Typical Low
$34.67
Median
$51.29
Typical High
$77.62

Where Arizona 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.

Arizona· 40th of 51

$51.29

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.