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

Idaho 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 $89 · 10th–90th $40$1410%20%10th90th$89Professionalmedian $93 · 10th–90th $58$1910%10%20%10th90th$93$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
Professional
Modifier
Global
Typical Low
$57.54
Median
$72.44
Typical High
$112.20
BCBS
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$281.84
BCBS
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$190.55
Typical High
$190.55
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$54.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$89.13
Typical High
$141.25
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$85.11
Typical High
$107.15
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$147.91
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$112.20
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$63.10
Typical High
$123.03
Select Health
Setting
Facility
Modifier
Global
Typical Low
$89.13
Median
$89.13
Typical High
$234.42
Select Health
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$114.82
Typical High
$173.78
United
Setting
Facility
Modifier
Global
Typical Low
$0.16
Median
$109.65
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$95.50
Typical High
$125.89