go back

Sacroiliac Orthosis, Flexible, Off-the-Shelf

Illinois 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 $71 · 10th–90th $38$3550%10%20%10th90th$71Professionalmedian $48 · 10th–90th $38$760%20%10th90th$48$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
$38.02
Median
$54.95
Typical High
$79.43
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$40.74
Typical High
$66.07
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$51.29
BCBS
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$257.04
Typical High
$645.65
BCBS
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$48.98
Typical High
$48.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$117.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$85.11
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$107.15
Typical High
$141.25
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$81.28
Molina
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$67.61
United
Setting
Facility
Modifier
Global
Typical Low
$51.29
Median
$52.48
Typical High
$87.10
United
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$51.29
Typical High
$87.10