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

Arkansas 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 $398,107 · 10th–90th $72$891,2510%10%20%10th90th$398,107Professionalmedian $72 · 10th–90th $63$1260%50%10th90th$72$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
$72.44
Median
$72.44
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$125.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$218,776.16
Median
$524,807.46
Typical High
$954,992.59
BCBS
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$114.82
Typical High
$151.36
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
$52.48
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$102.33
Typical High
$213.80
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$107.15
Typical High
$158.49