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Sacroiliac Orthosis, Flexible, Off-the-Shelf

New Jersey 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?

$53.70

Typical negotiated rate. In New Jersey, October 2026.

Insurers have agreed to pay about $53.70 for this service. The price depends on where it is billed: about $52.48 from a physician practice, and about $67.61 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$52.48$42.66 to $91.20
FacilityA hospital or hospital-owned outpatient department$67.61$67.61 to $67.61

How much rates vary

Facilitymedian $68 · 10th to 90th $37 to $78Professionalmedian $52 · 10th to 90th $37 to $91
$50$100facility $68professional $52

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
$37.15
Median
$37.15
Typical High
$42.66
Aetna
Setting
Professional
Modifier
None
Typical Low
$37.15
Median
$37.15
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
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$43.65
Median
$87.10
Typical High
$87.10
Horizon BCBS
Setting
Professional
Modifier
None
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Horizon BCBS
Setting
Professional
Modifier
RR · Rental
Typical Low
$9.12
Median
$9.12
Typical High
$9.12
United
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$107.15
Typical High
$128.82
United
Setting
Professional
Modifier
None
Typical Low
$38.90
Median
$56.23
Typical High
$79.43

Where New Jersey 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 Jersey· 35th of 51

$53.70

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.