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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 July 2026.

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

$64.57

Typical negotiated rate. In New Hampshire, July 2026.

Insurers have agreed to pay about $64.57 for this service. The price depends on where it is billed: about $64.57 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 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$64.57$63.10 to $64.57
FacilityA hospital or hospital-owned outpatient department$79.43$75.86 to $83.18

How much rates vary

Facilitymedian $79 · 10th to 90th $69 to $93Professionalmedian $65 · 10th to 90th $48 to $83
$50$100facility $79professional $65

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
$69.18
Median
$69.18
Typical High
$83.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$69.18
Typical High
$83.18
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$81.28
Typical High
$93.33
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$120.23
United
Setting
Facility
Modifier
Global
Typical Low
$31.62
Median
$51.29
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$64.57
Typical High
$91.20
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$128.82

Where New Hampshire 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.

New Hampshire· 8th of 51

$64.57

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.