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

Maryland 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 $52$1200%10%20%10th90th$93Professionalmedian $72 · 10th–90th $58$1450%20%10th90th$72$50.0$100.0$200.0$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
Professional
Modifier
Global
Typical Low
$57.54
Median
$67.61
Typical High
$144.54
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$81.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$54.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$38.02
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$123.03
Typical High
$190.55
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$93.33
Typical High
$120.23
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$109.65
Typical High
$169.82
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$102.33