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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Utah 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?

$48.98

Typical negotiated rate. In Utah, July 2026.

Insurers have agreed to pay about $48.98 for this service. The price depends on where it is billed: about $50.12 from a physician practice, and about $47.86 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 7 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$50.12$33.11 to $66.07
FacilityA hospital or hospital-owned outpatient department$47.86$33.11 to $48.98

How much rates vary

Facilitymedian $48 · 10th to 90th $33 to $51Professionalmedian $50 · 10th to 90th $22 to $141
$20$50$100facility $48professional $50

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
$33.11
Median
$47.86
Typical High
$47.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$63.10
Typical High
$141.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$67.61
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$69.18
Molina
Setting
Professional
Modifier
Global
Typical Low
$21.88
Median
$26.92
Typical High
$104.71
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$48.98
Typical High
$66.07
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$35.48
Typical High
$70.79
Select Health
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$50.12
Typical High
$50.12
Select Health
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$50.12
Typical High
$104.71
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$50.12
Typical High
$74.13
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$51.29
Typical High
$64.57
United
Setting
Professional
Modifier
Global
Typical Low
$12.88
Median
$48.98
Typical High
$74.13

Where Utah 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.

Utah· 37th of 51

$48.98

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.