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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.

Facilitymedian $117 · 10th–90th $39$1450%50%10th90th$117Professionalmedian $69 · 10th–90th $39$1450%20%10th90th$69$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
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