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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Oklahoma 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 $51 · 10th–90th $40$1290%20%40%10th90th$51Professionalmedian $63 · 10th–90th $40$760%20%10th90th$63$20.0$50.0$100.0$200.0$500.0

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
$39.81
Median
$40.74
Typical High
$40.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$41.69
Typical High
$63.10
BCBS
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
BCBS
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86
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
$85.11
Medica
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$67.61
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$53.70
Typical High
$112.20
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$72.44
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$51.29
Typical High
$74.13