go back

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 July 2026.

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

$72.44

Typical negotiated rate. In South Dakota, July 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 $93.33 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 8 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$72.44$63.10 to $89.13
FacilityA hospital or hospital-owned outpatient department$93.33$67.61 to $117

How much rates vary

Facilitymedian $93 · 10th to 90th $63 to $158Professionalmedian $72 · 10th to 90th $56 to $107
$50$100$200$500facility $93professional $72

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. 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
Global
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
Aetna
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$63.10
Typical High
$69.18
Avera
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$112.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$117.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$107.15
Medica
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$100.00
Typical High
$190.55
Medica
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$74.13
Typical High
$524.81
Midlands
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$123.03
Midlands
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Midlands
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$123.03
Typical High
$229.09
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$83.18
Typical High
$107.15
United
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$60.26
Typical High
$87.10
United
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$75.86
Typical High
$102.33
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$104.71
Typical High
$104.71

Where South Dakota 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.

South Dakota· 5th of 51

$72.44

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.