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Sacroiliac Orthosis, Flexible, Off-the-Shelf

South Dakota 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?

$85.11

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $85.11 for this service. The price depends on where it is billed: about $85.11 from a physician practice, and about $117 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$85.11$69.18 to $107
FacilityA hospital or hospital-owned outpatient department$117$93.33 to $117

How much rates vary

Facilitymedian $117 · 10th to 90th $81 to $191Professionalmedian $85 · 10th to 90th $51 to $115
$20$50$100$200$500facility $117professional $85

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
$93.33
Median
$93.33
Typical High
$93.33
Aetna
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$69.18
Typical High
$69.18
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$117.49
Cigna
Setting
Professional
Modifier
None
Typical Low
$85.11
Median
$107.15
Typical High
$117.49
Medica
Setting
Facility
Modifier
None
Typical Low
$93.33
Median
$117.49
Typical High
$190.55
Medica
Setting
Professional
Modifier
None
Typical Low
$51.29
Median
$72.44
Typical High
$524.81
Midlands
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$114.82
Typical High
$117.49
Midlands
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$123.03
Typical High
$229.09
Sanford Health Plan
Setting
Professional
Modifier
None
Typical Low
$72.44
Median
$72.44
Typical High
$107.15
United
Setting
Professional
Modifier
None
Typical Low
$43.65
Median
$57.54
Typical High
$91.20
Wellmark
Setting
Professional
Modifier
None
Typical Low
$104.71
Median
$104.71
Typical High
$104.71

Where South Dakota 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.

South Dakota· 6th of 51

$85.11

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.