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

Nationwide 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 $78 · 10th–90th $32$2400%10%20%10th90th$78Professionalmedian $83 · 10th–90th $50$1740%20%10th90th$83$0.2$2.0$20.0$200.0$2.0K$20.0K$200.0K

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
$60.26
Median
$74.13
Typical High
$162.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$74.13
Typical High
$144.54
BCBS
Setting
Facility
Modifier
Global
Typical Low
$29.51
Median
$39.81
Typical High
$169.82
BCBS
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$56.23
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$512.86
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$190.55
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$109.65
Typical High
$213.80
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$107.15
Typical High
$169.82