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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Hawaii 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?

$129

Typical negotiated rate. In Hawaii, October 2026.

Insurers have agreed to pay about $129 for this service. Most negotiated rates run $97.72 to $135.

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.

How much rates vary

Facilitymedian $115 · 10th to 90th $78 to $115Professionalmedian $129 · 10th to 90th $98 to $138
$100facility $115professional $129

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
Professional
Modifier
None
Typical Low
$37.15
Median
$63.10
Typical High
$66.07
Cigna
Setting
Facility
Modifier
None
Typical Low
$77.62
Median
$114.82
Typical High
$114.82
Cigna
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
HMSA
Setting
Professional
Modifier
None
Typical Low
$128.82
Median
$128.82
Typical High
$134.90
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$75.86
Median
$128.82
Typical High
$165.96
United
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$138.04
Typical High
$138.04
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$97.72
Median
$97.72
Typical High
$97.72

Where Hawaii 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.

Hawaii· 1st of 51

$129

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.