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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Washington, DC 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?

$56.23

Typical negotiated rate. In Washington, DC, October 2026.

Insurers have agreed to pay about $56.23 for this service. Most negotiated rates run $43.65 to $57.54.

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.

How much rates vary

Facilitymedian $31 · 10th to 90th $31 to $74Professionalmedian $56 · 10th to 90th $31 to $68
$50$100facility $31professional $56

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
$30.90
Median
$30.90
Typical High
$30.90
Aetna
Setting
Professional
Modifier
None
Typical Low
$30.90
Median
$30.90
Typical High
$53.70
CareFirst
Setting
Professional
Modifier
None
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
Cigna
Setting
Facility
Modifier
None
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
Cigna
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$43.65
Median
$57.54
Typical High
$147.91
United
Setting
Professional
Modifier
None
Typical Low
$34.67
Median
$52.48
Typical High
$70.79

Where Washington, DC 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.

Washington, DC· 32nd of 51

$56.23

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.