go back

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

Massachusetts 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 $72$6030%20%10th90th$117Professionalmedian $117 · 10th–90th $72$1700%20%40%10th90th$117$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
$72.44
Median
$72.44
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$144.54
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$147.91
Typical High
$602.56
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$128.82
Typical High
$190.55
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
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$3,630.78
Typical High
$9,772.37
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$177.83
Health New England
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$234.42
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$147.91
Typical High
$602.56
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$128.82
Typical High
$190.55
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$125.89
Typical High
$213.80
United
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$117.49
Typical High
$165.96