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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Nebraska 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?

$42.66

Typical negotiated rate. In Nebraska, July 2026.

Insurers have agreed to pay about $42.66 for this service. The price depends on where it is billed: about $42.66 from a physician practice, and about $79.43 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 7 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$42.66$39.81 to $63.10
FacilityA hospital or hospital-owned outpatient department$79.43$67.61 to $107

How much rates vary

Facilitymedian $79 · 10th to 90th $51 to $240Professionalmedian $43 · 10th to 90th $40 to $74
$50$100$200facility $79professional $43

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
Facility
Modifier
Global
Typical Low
$57.54
Median
$79.43
Typical High
$79.43
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$42.66
Typical High
$63.10
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$81.28
Typical High
$190.55
BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$70.79
Typical High
$70.79
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$77.62
Typical High
$117.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$109.65
Typical High
$263.03
Medica
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$100.00
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$67.61
Typical High
$109.65
Midlands
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$288.40
Midlands
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Midlands
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$263.03
Typical High
$288.40
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$75.86
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$60.26
Typical High
$89.13

Where Nebraska 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.

Nebraska· 48th of 51

$42.66

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.