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

Kentucky 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 $93 · 10th–90th $78$1860%20%40%10th90th$93Professionalmedian $72 · 10th–90th $39$2000%10%20%10th90th$72$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$79.43
Median
$79.43
Typical High
$83.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$74.13
Typical High
$114.82
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$138.04
Typical High
$144.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$338.84
CareSource
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$186.21
Typical High
$53,703.18
CareSource
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$165.96
Typical High
$213.80
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$186.21
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$52.48
Typical High
$616.60
Molina
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$151.36
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$93.33
Typical High
$117.49
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$107.15
Typical High
$151.36