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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.

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

$204

Typical negotiated rate. In Hawaii, July 2026.

Insurers have agreed to pay about $204 for this service. Most negotiated rates run $126 to $204.

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 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $76 · 10th to 90th $52 to $117Professionalmedian $204 · 10th to 90th $72 to $214
$50$100$200facility $76professional $204

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. 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
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

Where Hawaii sits

The same service costs 3.9 times more in Hawaii than in California. 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

$204

HI $204CA $52.48

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.