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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.

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

$74.13

Typical negotiated rate. In Arizona, July 2026.

Insurers have agreed to pay about $74.13 for this service. The price depends on where it is billed: about $74.13 from a physician practice, and about $115 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 5 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$74.13$52.48 to $97.72
FacilityA hospital or hospital-owned outpatient department$115$54.95 to $170

How much rates vary

Facilitymedian $115 · 10th to 90th $33 to $275Professionalmedian $74 · 10th to 90th $40 to $158
$50$100$200$500$1Kfacility $115professional $74

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where Arizona sits

The same service costs 3.9 times more in Hawaii than in California. 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.

Arizona· 35th of 51

$74.13

HI $204CA $52.48

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.