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Sacroiliac Orthosis, Flexible, Off-the-Shelf

North Dakota 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?

$83.18

Typical negotiated rate. In North Dakota, October 2026.

Insurers have agreed to pay about $83.18 for this service. The price depends on where it is billed: about $81.28 from a physician practice, and about $93.33 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$81.28$61.66 to $83.18
FacilityA hospital or hospital-owned outpatient department$93.33$93.33 to $93.33

How much rates vary

Facilitymedian $93 · 10th to 90th $56 to $282Professionalmedian $81 · 10th to 90th $51 to $93
$50$100$200facility $93professional $81

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
Aetna
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$93.33
Typical High
$93.33
BCBS North Dakota
Setting
Professional
Modifier
None
Typical Low
$61.66
Median
$83.18
Typical High
$83.18
BCBS North Dakota
Setting
Professional
Modifier
22 · Increased work
Typical Low
$74.13
Median
$100.00
Typical High
$100.00
Cigna
Setting
Facility
Modifier
None
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
Cigna
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$85.11
Typical High
$107.15
Medica
Setting
Facility
Modifier
None
Typical Low
$39.81
Median
$93.33
Typical High
$323.59
Medica
Setting
Professional
Modifier
None
Typical Low
$46.77
Median
$57.54
Typical High
$102.33
United
Setting
Professional
Modifier
None
Typical Low
$29.51
Median
$57.54
Typical High
$102.33

Where North Dakota 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.

North Dakota· 8th of 51

$83.18

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.