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

Arizona 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 $115 · 10th–90th $33$2750%10%10th90th$115Professionalmedian $74 · 10th–90th $40$1580%20%10th90th$74$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
Professional
Modifier
Global
Typical Low
$48.98
Median
$72.44
Typical High
$104.71
BCBS
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$141.25
Typical High
$275.42
BCBS
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$131.83
Typical High
$263.03
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
$52.48
Medica
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$72.44
Typical High
$575.44
Medica
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$95.50
Typical High
$891.25
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$102.33
Typical High
$128.82
United
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$95.50
Typical High
$158.49