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

Georgia 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 $138 · 10th–90th $81$5010%20%10th90th$138Professionalmedian $102 · 10th–90th $69$1950%10%20%10th90th$102$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
$81.28
Median
$81.28
Typical High
$213.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$81.28
Typical High
$144.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$323.59
Typical High
$501.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$177.83
Typical High
$218.78
CareSource
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$134.90
CareSource
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
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
$151.36
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$302.00
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$93.33
Typical High
$138.04
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$107.15
Typical High
$177.83