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

Delaware 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 $52 · 10th–90th $0$930%20%40%10th90th$52Professionalmedian $62 · 10th–90th $62$2240%20%40%90th$62$0.2$1.0$5.0$20.0$100.0

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
$61.66
Median
$61.66
Typical High
$223.87
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
$154.88
United
Setting
Facility
Modifier
Global
Typical Low
$0.16
Median
$75.86
Typical High
$93.33
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$120.23
Typical High
$169.82