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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 October 2026.

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

$35.48

Typical negotiated rate. In Utah, October 2026.

Insurers have agreed to pay about $35.48 for this service. The price depends on where it is billed: about $35.48 from a physician practice, and about $48.98 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$35.48$33.11 to $51.29
FacilityA hospital or hospital-owned outpatient department$48.98$33.11 to $67.61

How much rates vary

Facilitymedian $49 · 10th to 90th $33 to $68Professionalmedian $35 · 10th to 90th $27 to $71
$20$50$100facility $49professional $35

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
$33.11
Median
$33.11
Typical High
$33.11
Aetna
Setting
Professional
Modifier
None
Typical Low
$33.11
Median
$33.11
Typical High
$45.71
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$74.13
Cigna
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$48.98
Typical High
$67.61
Molina
Setting
Professional
Modifier
None
Typical Low
$26.92
Median
$26.92
Typical High
$60.26
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$47.86
Median
$48.98
Typical High
$114.82
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$35.48
Median
$35.48
Typical High
$37.15
Select Health
Setting
Facility
Modifier
None
Typical Low
$50.12
Median
$50.12
Typical High
$50.12
Select Health
Setting
Professional
Modifier
None
Typical Low
$25.12
Median
$97.72
Typical High
$107.15
U of Utah Health Plan
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$56.23
Typical High
$97.72
United
Setting
Professional
Modifier
None
Typical Low
$19.05
Median
$51.29
Typical High
$51.29

Where Utah 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.

Utah· 51st of 51

$35.48

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.