go back

Sacroiliac Orthosis, Flexible, Off-the-Shelf

New York 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?

$63.10

Typical negotiated rate. In New York, July 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 $67.61 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 9 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$63.10$47.86 to $74.13
FacilityA hospital or hospital-owned outpatient department$67.61$51.29 to $87.10

How much rates vary

Facilitymedian $68 · 10th to 90th $39 to $123Professionalmedian $63 · 10th to 90th $39 to $123
$100$1K$10Kfacility $68professional $63

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
$37.15
Median
$47.86
Typical High
$89.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$47.86
Typical High
$75.86
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$134.90
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$169.82
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$81.28
Typical High
$81.28
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$69.18
Typical High
$104.71
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$77.62
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$109.65
Typical High
$257.04
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$43.65
Median
$70.79
Typical High
$128.82
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$77.62
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$67.61
Typical High
$74.13
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$63.10
Typical High
$102.33
United
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$60.26
Typical High
$165.96
United
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$61.66
Typical High
$112.20
Univera
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$77.62
Univera
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$67.61
Typical High
$74.13

Where New York 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 York· 16th of 51

$63.10

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.