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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 July 2026.

Facilitymedian $76 · 10th–90th $44$2820%20%10th90th$76Professionalmedian $62 · 10th–90th $39$1070%10%20%10th90th$62$0.1$0.5$2.0$10.0$50.0$200.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$43.65
Typical High
$112.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$47.86
Typical High
$107.15
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$70.79
Typical High
$177.83
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$181.97
Typical High
$281.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$61.66
Median
$89.13
Typical High
$125.89
CareSource
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
CareSource
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$102.33
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$75.86
Typical High
$213.80
United
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$51.29
Typical High
$75.86
United
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$52.48
Typical High
$85.11