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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Vermont 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?

$60.26

Typical negotiated rate. In Vermont, October 2026.

Insurers have agreed to pay about $60.26 for this service. Most negotiated rates run $48.98 to $74.13.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $74 · 10th to 90th $68 to $78Professionalmedian $59 · 10th to 90th $49 to $102
$50$100$200facility $74professional $59

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
$34.67
Median
$58.88
Typical High
$58.88
BCBS Vermont
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$74.13
Typical High
$77.62
Cigna
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$48.98
Typical High
$74.13
MVP Health Care
Setting
Professional
Modifier
None
Typical Low
$72.44
Median
$95.50
Typical High
$95.50
United
Setting
Professional
Modifier
None
Typical Low
$46.77
Median
$91.20
Typical High
$177.83

Where Vermont 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.

Vermont· 30th of 51

$60.26

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.