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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Minnesota 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?

$85.11

Typical negotiated rate. In Minnesota, October 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $81.28 from a physician practice, and about $89.13 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$81.28$57.54 to $91.20
FacilityA hospital or hospital-owned outpatient department$89.13$51.29 to $191

How much rates vary

Facilitymedian $89 · 10th to 90th $51 to $324Professionalmedian $81 · 10th to 90th $47 to $107
$50$100$200$500facility $89professional $81

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
$51.29
Median
$51.29
Typical High
$51.29
Aetna
Setting
Professional
Modifier
None
Typical Low
$46.77
Median
$51.29
Typical High
$63.10
BCBS Minnesota
Setting
Facility
Modifier
None
Typical Low
$81.28
Median
$89.13
Typical High
$158.49
BCBS Minnesota
Setting
Professional
Modifier
None
Typical Low
$72.44
Median
$89.13
Typical High
$91.20
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$251.19
Typical High
$630.96
Cigna
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$89.13
Typical High
$107.15
Health Partners
Setting
Facility
Modifier
None
Typical Low
$158.49
Median
$251.19
Typical High
$602.56
Health Partners
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Medica
Setting
Facility
Modifier
None
Typical Low
$34.67
Median
$81.28
Typical High
$323.59
Medica
Setting
Professional
Modifier
None
Typical Low
$41.69
Median
$57.54
Typical High
$223.87
United
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$128.82
Typical High
$151.36
United
Setting
Professional
Modifier
None
Typical Low
$34.67
Median
$56.23
Typical High
$104.71

Where Minnesota 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.

Minnesota· 6th of 51

$85.11

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.