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 October 2026.
How much does Sacroiliac Orthosis, Rigid or Semi-Rigid, Off-the-Shelf cost?
$63.10
Typical negotiated rate. In Indiana, October 2026.
Insurers have agreed to pay about $63.10 for this service. The price depends on where it is billed: about $58.88 from a physician practice, and about $117 from a hospital or other facility.
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.
Prices by location type
Billed by
Who charges it
Typical
Range
Physician practiceA doctor's office, clinic or independent provider
A doctor's office, clinic or independent provider
$58.88
$38.90 to $107
FacilityA hospital or hospital-owned outpatient department
A hospital or hospital-owned outpatient department
$117
$91.20 to $117
How much rates vary
Facilitymedian $117 · 10th to 90th $52 to $282Professionalmedian $59 · 10th to 90th $39 to $174
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Aetna
Setting
Facility
Modifier
None
Typical Low
$69.18
Median
$69.18
Typical High
$69.18
Facility
None
$69.18
$69.18
$69.18
Aetna
Setting
Professional
Modifier
None
Typical Low
$66.07
Median
$69.18
Typical High
$93.33
Professional
None
$66.07
$69.18
$93.33
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$91.20
Median
$117.49
Typical High
$123.03
Facility
None
$91.20
$117.49
$123.03
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$38.90
Median
$39.81
Typical High
$128.82
Professional
None
$38.90
$39.81
$128.82
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$29.51
Median
$29.51
Typical High
$45.71
Professional
UE · Used equipment
$29.51
$29.51
$45.71
CareSource
Setting
Facility
Modifier
None
Typical Low
$194.98
Median
$194.98
Typical High
$199.53
Facility
None
$194.98
$194.98
$199.53
Cigna
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$56.23
Typical High
$117.49
Facility
None
$52.48
$56.23
$117.49
Cigna
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$51.29
Typical High
$616.60
Professional
None
$38.02
$51.29
$616.60
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$173.78
Median
$371.54
Typical High
$2,187.76
Facility
None
$173.78
$371.54
$2,187.76
Physicians Health Plan of Northern Indiana
Setting
Professional
Modifier
None
Typical Low
$72.44
Median
$95.50
Typical High
$181.97
Professional
None
$72.44
$95.50
$181.97
United
Setting
Professional
Modifier
None
Typical Low
$63.10
Median
$107.15
Typical High
$173.78
Professional
None
$63.10
$107.15
$173.78
1 more rate with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Anthem BCBS
Setting
Professional
Modifier
RR · Rental
Typical Low
$8.51
Median
$10.72
Typical High
$39.81
Professional
RR · Rental
$8.51
$10.72
$39.81
Where Indiana 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.