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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 July 2026.

How much does Sacroiliac Orthosis, Flexible, Off-the-Shelf cost?

$63.10

Typical negotiated rate. In Montana, July 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 $67.61 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$63.10$47.86 to $100
FacilityA hospital or hospital-owned outpatient department$67.61$47.86 to $100

How much rates vary

Facilitymedian $68 · 10th to 90th $48 to $145Professionalmedian $63 · 10th to 90th $33 to $107
$100$1K$10K$100Kfacility $68professional $63

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
Professional
Modifier
Global
Typical Low
$24.55
Median
$63.10
Typical High
$141.25
BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$69,183.10
Typical High
$91,201.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$107.15
Typical High
$107.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$107.15
Typical High
$107.15
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$56.23
Typical High
$107.15
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$56.23
Typical High
$107.15
Providence
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$85.11
Typical High
$131.83
Providence
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$79.43
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$54.95
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$51.29
Typical High
$79.43

Where Montana 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.

Montana· 12th of 51

$63.10

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.