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

Alaska 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 October 2026.

How much does Sacroiliac Orthosis, Rigid or Semi-Rigid, Off-the-Shelf cost?

$191

Typical negotiated rate. In Alaska, October 2026.

Insurers have agreed to pay about $191 for this service. The price depends on where it is billed: about $191 from a physician practice, and about $170 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$191$162 to $191
FacilityA hospital or hospital-owned outpatient department$170$56.23 to $191

How much rates vary

Facilitymedian $170 · 10th to 90th $52 to $204Professionalmedian $191 · 10th to 90th $69 to $204
$50$100$200$500facility $170professional $191

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
Aetna
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$169.82
Typical High
$169.82
Cigna
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$52.48
Typical High
$56.23
Cigna
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$38.02
Typical High
$218.78
Moda Health
Setting
Facility
Modifier
None
Typical Low
$28.84
Median
$190.55
Typical High
$245.47
Moda Health
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$190.55
Typical High
$204.17
Premera BCBS
Setting
Facility
Modifier
None
Typical Low
$89.13
Median
$89.13
Typical High
$204.17
Premera BCBS
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$190.55
Typical High
$199.53
Premera BCBS
Setting
Professional
Modifier
NR · New when rented
Typical Low
$173.78
Median
$190.55
Typical High
$190.55
Providence
Setting
Facility
Modifier
None
Typical Low
$28.84
Median
$56.23
Typical High
$245.47
Providence
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$56.23
Typical High
$218.78
United
Setting
Professional
Modifier
None
Typical Low
$102.33
Median
$154.88
Typical High
$257.04

Where Alaska sits

The same service costs 5.4 times more in Hawaii than in New Hampshire. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Alaska· 2nd of 51

$191

HI $214NH $39.81

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.