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

Louisiana 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 $166 · 10th–90th $110$3800%20%10th90th$166Professionalmedian $107 · 10th–90th $71$1350%20%10th90th$107$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
$123.03
Median
$123.03
Typical High
$123.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$107.15
Typical High
$134.90
BCBS
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$316.23
Typical High
$446.68
BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Christus
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$151.36
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$141.25
Typical High
$213.80
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$107.15
Typical High
$158.49