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

Florida 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 $78 · 10th–90th $50$3310%20%10th90th$78Professionalmedian $74 · 10th–90th $50$1660%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
Facility
Modifier
Global
Typical Low
$50.12
Median
$72.44
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$72.44
Typical High
$169.82
AvMed
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
AvMed
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$138.04
Typical High
$147.91
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$83.18
Typical High
$177.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$36.31
Typical High
$41.69
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$109.65
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$107.15
Typical High
$158.49
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$36.31
Typical High
$138.04