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

Colorado 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 $83 · 10th–90th $29$1620%20%10th90th$83Professionalmedian $71 · 10th–90th $39$1200%20%10th90th$71$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
Facility
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$69.18
Typical High
$85.11
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$109.65
Typical High
$194.98
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$39.81
Typical High
$199.53
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
$61.66
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$74.13
Typical High
$165.96
Denver HMP
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$89.13
Typical High
$331.13
Select Health
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$165.96
Typical High
$190.55
Select Health
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$112.20
Typical High
$177.83
United
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$93.33
Typical High
$117.49
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$95.50
Typical High
$158.49