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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 October 2026.

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

$81.28

Typical negotiated rate. In Nebraska, October 2026.

Insurers have agreed to pay about $81.28 for this service. The price depends on where it is billed: about $74.13 from a physician practice, and about $115 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$74.13$57.54 to $115
FacilityA hospital or hospital-owned outpatient department$115$97.72 to $117

How much rates vary

Facilitymedian $115 · 10th to 90th $58 to $324Professionalmedian $74 · 10th to 90th $44 to $145
$50$100$200$500facility $115professional $74

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
$47.86
Median
$47.86
Typical High
$47.86
Aetna
Setting
Professional
Modifier
None
Typical Low
$39.81
Median
$47.86
Typical High
$125.89
Ambetter
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$117.49
Typical High
$117.49
Cigna
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$114.82
Typical High
$281.84
Medica
Setting
Facility
Modifier
None
Typical Low
$57.54
Median
$97.72
Typical High
$323.59
Medica
Setting
Professional
Modifier
None
Typical Low
$39.81
Median
$67.61
Typical High
$107.15
Midlands
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$117.49
Typical High
$288.40
Midlands
Setting
Professional
Modifier
None
Typical Low
$158.49
Median
$263.03
Typical High
$288.40
United
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
United
Setting
Professional
Modifier
None
Typical Low
$32.36
Median
$63.10
Typical High
$77.62

Where Nebraska 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.

Nebraska· 9th of 51

$81.28

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.