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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Montana 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?

$100

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $100 for this service. The price depends on where it is billed: about $100 from a physician practice, and about $107 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$100$57.54 to $107
FacilityA hospital or hospital-owned outpatient department$107$63.10 to $2,884

How much rates vary

Facilitymedian $107 · 10th to 90th $50 to $2,951Professionalmedian $100 · 10th to 90th $51 to $107
$50$100$200$500$1K$2Kfacility $107professional $100

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
Professional
Modifier
None
Typical Low
$24.55
Median
$63.10
Typical High
$70.79
BCBS Montana
Setting
Facility
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
BCBS Montana
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Cigna
Setting
Facility
Modifier
None
Typical Low
$97.72
Median
$107.15
Typical High
$107.15
Cigna
Setting
Professional
Modifier
None
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$50.12
Median
$97.72
Typical High
$2,951.21
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$50.12
Median
$63.10
Typical High
$3,090.30
Providence
Setting
Facility
Modifier
None
Typical Low
$57.54
Median
$107.15
Typical High
$107.15
Providence
Setting
Professional
Modifier
None
Typical Low
$57.54
Median
$79.43
Typical High
$107.15
United
Setting
Professional
Modifier
None
Typical Low
$46.77
Median
$51.29
Typical High
$87.10

Where Montana 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.

Montana· 5th of 51

$100

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.