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

Hawaii 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 $76 · 10th–90th $52$1170%20%10th90th$76Professionalmedian $204 · 10th–90th $72$2140%50%10th90th$204$10.0$20.0$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
$72.44
Median
$72.44
Typical High
$72.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$186.21
Typical High
$251.19
HMSA
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$213.80
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$204.17
Typical High
$281.84
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$117.49
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$165.96
Typical High
$295.12