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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Iowa 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?

$105

Typical negotiated rate. In Iowa, October 2026.

Insurers have agreed to pay about $105 for this service. The price depends on where it is billed: about $105 from a physician practice, and about $117 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$105$67.61 to $117
FacilityA hospital or hospital-owned outpatient department$117$95.50 to $275

How much rates vary

Facilitymedian $117 · 10th to 90th $89 to $324Professionalmedian $105 · 10th to 90th $51 to $141
$50$100$200$500facility $117professional $105

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
Facility
Modifier
None
Typical Low
$46.77
Median
$46.77
Typical High
$46.77
Aetna
Setting
Professional
Modifier
None
Typical Low
$41.69
Median
$46.77
Typical High
$70.79
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$117.49
Typical High
$117.49
Cigna
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$117.49
Typical High
$138.04
Hally Health
Setting
Professional
Modifier
None
Typical Low
$63.10
Median
$74.13
Typical High
$131.83
Medica
Setting
Facility
Modifier
None
Typical Low
$93.33
Median
$120.23
Typical High
$323.59
Medica
Setting
Professional
Modifier
None
Typical Low
$61.66
Median
$114.82
Typical High
$281.84
Midlands
Setting
Professional
Modifier
None
Typical Low
$117.49
Median
$117.49
Typical High
$125.89
Midlands
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$229.09
Typical High
$229.09
United
Setting
Facility
Modifier
None
Typical Low
$151.36
Median
$151.36
Typical High
$295.12
United
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$67.61
Typical High
$120.23
Wellmark
Setting
Professional
Modifier
None
Typical Low
$104.71
Median
$104.71
Typical High
$104.71

Where Iowa 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.

Iowa· 4th of 51

$105

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.