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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 July 2026.

Facilitymedian $29 · 10th–90th $29$1910%50%90th$29Professionalmedian $79 · 10th–90th $60$2240%10%20%10th90th$79$50.0$100.0$200.0$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
Professional
Modifier
Global
Typical Low
$48.98
Median
$72.44
Typical High
$169.82
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
$218.78
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$60.26
Typical High
$190.55
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$204.17
Typical High
$645.65
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$190.55
Typical High
$204.17
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$190.55
Typical High
$204.17
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$169.82
Providence
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$56.23
Typical High
$218.78
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$93.33
Typical High
$117.49
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$158.49
Typical High
$257.04