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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Indiana 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 Indiana, July 2026.

Insurers have agreed to pay about $51.29 for this service. The price depends on where it is billed: about $48.98 from a physician practice, and about $64.57 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 6 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$48.98$37.15 to $63.10
FacilityA hospital or hospital-owned outpatient department$64.57$57.54 to $64.57

How much rates vary

Facilitymedian $65 · 10th to 90th $37 to $98Professionalmedian $49 · 10th to 90th $34 to $85
$50$100$200facility $65professional $49

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
$37.15
Median
$37.15
Typical High
$37.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$40.74
Typical High
$74.13
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$69.18
Typical High
$97.72
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$64.57
Typical High
$109.65
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$63.10
Typical High
$97.72
CareSource
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$97.72
Typical High
$112.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$67.61
Typical High
$91.20
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$85.11
United
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$52.48
Typical High
$72.44
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$51.29
Typical High
$75.86

Where Indiana 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.

Indiana· 32nd 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.