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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Missouri 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?

$63.10

Typical negotiated rate. In Missouri, October 2026.

Insurers have agreed to pay about $63.10 for this service. The price depends on where it is billed: about $63.10 from a physician practice, and about $100 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$63.10$51.29 to $77.62
FacilityA hospital or hospital-owned outpatient department$100$67.61 to $302

How much rates vary

Facilitymedian $100 · 10th to 90th $47 to $324Professionalmedian $63 · 10th to 90th $47 to $115
$50$100$200$500facility $100professional $63

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
$53.70
Aetna
Setting
Professional
Modifier
None
Typical Low
$39.81
Median
$46.77
Typical High
$56.23
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$75.86
Median
$75.86
Typical High
$346.74
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$57.54
Median
$67.61
Typical High
$109.65
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$40.74
Median
$47.86
Typical High
$87.10
BCBS Kansas City
Setting
Professional
Modifier
None
Typical Low
$44.67
Median
$44.67
Typical High
$75.86
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$77.62
Cigna
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
Medica
Setting
Facility
Modifier
None
Typical Low
$46.77
Median
$109.65
Typical High
$323.59
Medica
Setting
Professional
Modifier
None
Typical Low
$44.67
Median
$67.61
Typical High
$524.81
United
Setting
Facility
Modifier
None
Typical Low
$128.82
Median
$128.82
Typical High
$128.82
United
Setting
Professional
Modifier
None
Typical Low
$43.65
Median
$63.10
Typical High
$87.10
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Anthem BCBS
Setting
Professional
Modifier
RR · Rental
Typical Low
$5.37
Median
$6.31
Typical High
$63.10

Where Missouri 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.

Missouri· 20th of 51

$63.10

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.