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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 July 2026.

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

$51.29

Typical negotiated rate. In Arizona, July 2026.

Insurers have agreed to pay about $51.29 for this service. The price depends on where it is billed: about $50.12 from a physician practice, and about $70.79 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 5 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$50.12$39.81 to $63.10
FacilityA hospital or hospital-owned outpatient department$70.79$38.90 to $148

How much rates vary

Facilitymedian $71 · 10th to 90th $31 to $240Professionalmedian $50 · 10th to 90th $28 to $107
$20$50$100$200$500facility $71professional $50

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
$61.66
Median
$61.66
Typical High
$61.66
Aetna
Setting
Professional
Modifier
Global
Typical Low
$27.54
Median
$47.86
Typical High
$66.07
BCBS
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$131.83
Typical High
$251.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$123.03
Typical High
$245.47
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
Medica
Setting
Facility
Modifier
Global
Typical Low
$30.90
Median
$69.18
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$51.29
Typical High
$524.81
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$57.54
Typical High
$72.44
United
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$51.29
Typical High
$77.62

Where Arizona 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.

Arizona· 33rd of 51

$51.29

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.