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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 October 2026.

How much does Sacroiliac Orthosis, Rigid or Semi-Rigid, Off-the-Shelf cost?

$214

Typical negotiated rate. In Hawaii, October 2026.

Insurers have agreed to pay about $214 for this service. Most negotiated rates run $204 to $219.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $52 · 10th to 90th $52 to $52Professionalmedian $214 · 10th to 90th $204 to $219
$50$100$200facility $52professional $214

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Cigna
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Cigna
Setting
Professional
Modifier
None
Typical Low
$218.78
Median
$218.78
Typical High
$218.78
HMSA
Setting
Professional
Modifier
None
Typical Low
$204.17
Median
$204.17
Typical High
$213.80
HMSA
Setting
Professional
Modifier
RR · Rental
Typical Low
$20.42
Median
$20.42
Typical High
$21.38
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$120.23
Median
$204.17
Typical High
$263.03
United
Setting
Professional
Modifier
None
Typical Low
$186.21
Median
$218.78
Typical High
$218.78
University Health Alliance
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$173.78
Typical High
$190.55

Where Hawaii sits

The same service costs 5.4 times more in Hawaii than in New Hampshire. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Hawaii· 1st of 51

$214

HI $214NH $39.81

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.