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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Rhode Island 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?

$72.44

Typical negotiated rate. In Rhode Island, October 2026.

Insurers have agreed to pay about $72.44 for this service. The price depends on where it is billed: about $72.44 from a physician practice, and about $170 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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$72.44$60.26 to $79.43
FacilityA hospital or hospital-owned outpatient department$170$155 to $219

How much rates vary

Facilitymedian $170 · 10th to 90th $129 to $251Professionalmedian $72 · 10th to 90th $49 to $102
$50$100$200facility $170professional $72

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
$58.88
Median
$72.44
Typical High
$72.44
BCBS Rhode Island
Setting
Facility
Modifier
None
Typical Low
$154.88
Median
$173.78
Typical High
$251.19
BCBS Rhode Island
Setting
Professional
Modifier
None
Typical Low
$56.23
Median
$79.43
Typical High
$102.33
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$67.61
Cigna
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
United
Setting
Facility
Modifier
None
Typical Low
$128.82
Median
$128.82
Typical High
$128.82
United
Setting
Professional
Modifier
None
Typical Low
$40.74
Median
$64.57
Typical High
$102.33

Where Rhode Island 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.

Rhode Island· 11th of 51

$72.44

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.