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Sacroiliac Orthosis, Rigid or Semi-Rigid, Off-the-Shelf

Oklahoma rates for HCPCS L0623

Sacroiliac orthosis (SO), provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf

Rates data updated July 2026.

Facilitymedian $74 · 10th–90th $72$1820%20%40%10th90th$74Professionalmedian $76 · 10th–90th $63$1580%20%40%10th90th$76$50.0$100.0$200.0$500.0$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
$72.44
Median
$74.13
Typical High
$74.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$74.13
Typical High
$83.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$151.36
Medica
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$83.18
Typical High
$501.19
Medica
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$107.15
Typical High
$204.17
United
Setting
Facility
Modifier
Global
Typical Low
$79.43
Median
$128.82
Typical High
$181.97
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$95.50
Typical High
$158.49