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Sacroiliac Orthosis, Flexible, Off-the-Shelf

New Hampshire 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?

$63.10

Typical negotiated rate. In New Hampshire, October 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 $77.62 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$63.10$60.26 to $64.57
FacilityA hospital or hospital-owned outpatient department$77.62$74.13 to $83.18

How much rates vary

Facilitymedian $78 · 10th to 90th $68 to $93Professionalmedian $63 · 10th to 90th $49 to $79
$50$100facility $78professional $63

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
Professional
Modifier
None
Typical Low
$53.70
Median
$69.18
Typical High
$69.18
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$69.18
Median
$81.28
Typical High
$95.50
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Anthem BCBS
Setting
Professional
Modifier
RR · Rental
Typical Low
$6.31
Median
$6.31
Typical High
$6.31
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$77.62
Cigna
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$40.74
Median
$64.57
Typical High
$107.15
United
Setting
Professional
Modifier
None
Typical Low
$40.74
Median
$60.26
Typical High
$97.72
Well Sense
Setting
Facility
Modifier
None
Typical Low
$74.13
Median
$74.13
Typical High
$74.13

Where New Hampshire 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.

New Hampshire· 21st of 51

$63.10

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.