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

Illinois 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 $93 · 10th–90th $72$4790%20%10th90th$93Professionalmedian $79 · 10th–90th $72$1580%20%40%10th90th$79$0.2$1.0$5.0$20.0$100.0$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
$72.44
Median
$72.44
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$74.13
Typical High
$117.49
BCBS
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$186.21
Typical High
$1,380.38
BCBS
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$89.13
Typical High
$89.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$194.98
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$151.36
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$204.17
Typical High
$269.15
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
$147.91
Median
$147.91
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$93.33
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$107.15
Typical High
$173.78