go back

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

Connecticut 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 $117 · 10th–90th $52$1380%20%10th90th$117Professionalmedian $72 · 10th–90th $39$1580%20%40%10th90th$72$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$72.44
Typical High
$229.09
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$138.04
Typical High
$165.96
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$134.90
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$120.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$38.02
ConnectiCare
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$87.10
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$97.72
Typical High
$138.04
Health New England
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$93.33
Typical High
$134.90
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$104.71
Typical High
$165.96