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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Georgia 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?

$75.86

Typical negotiated rate. In Georgia, October 2026.

Insurers have agreed to pay about $75.86 for this service. The price depends on where it is billed: about $74.13 from a physician practice, and about $75.86 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$74.13$63.10 to $95.50
FacilityA hospital or hospital-owned outpatient department$75.86$67.61 to $263

How much rates vary

Facilitymedian $76 · 10th to 90th $68 to $282Professionalmedian $74 · 10th to 90th $51 to $214
$50$100$200facility $76professional $74

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$43.65
Median
$43.65
Typical High
$61.66
Aetna
Setting
Professional
Modifier
None
Typical Low
$41.69
Median
$51.29
Typical High
$107.15
Ambetter
Setting
Professional
Modifier
None
Typical Low
$56.23
Median
$70.79
Typical High
$177.83
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$75.86
Median
$263.03
Typical High
$281.84
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$79.43
Typical High
$316.23
Anthem BCBS
Setting
Professional
Modifier
RR · Rental
Typical Low
$6.31
Median
$7.94
Typical High
$31.62
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$47.86
Median
$63.10
Typical High
$239.88
CareSource
Setting
Facility
Modifier
None
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
CareSource
Setting
Professional
Modifier
None
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$77.62
Cigna
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$48.98
Typical High
$102.33
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$66.07
Median
$75.86
Typical High
$213.80
United
Setting
Professional
Modifier
None
Typical Low
$36.31
Median
$53.70
Typical High
$95.50

Where Georgia 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.

Georgia· 10th of 51

$75.86

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.