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

Indiana 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?

$72.44

Typical negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $72.44 for this service. The price depends on where it is billed: about $69.18 from a physician practice, and about $117 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$69.18$54.95 to $81.28
FacilityA hospital or hospital-owned outpatient department$117$75.86 to $117

How much rates vary

Facilitymedian $117 · 10th to 90th $39 to $145Professionalmedian $69 · 10th to 90th $39 to $145
$50$100$200facility $117professional $69

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. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$69.18
Median
$69.18
Typical High
$69.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$72.44
Typical High
$114.82
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$117.49
Typical High
$144.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$39.81
Typical High
$199.53
CareSource
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$173.78
Typical High
$199.53
Cigna
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$52.48
Typical High
$213.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$158.49
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$93.33
Typical High
$147.91
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$107.15
Typical High
$158.49

Where Indiana 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.

Indiana· 41st of 51

$72.44

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.