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

Maine 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 $158 · 10th–90th $52$1820%20%40%10th90th$158Professionalmedian $102 · 10th–90th $39$1260%20%10th90th$102$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$125.89
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$158.49
Typical High
$181.97
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
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
$52.48
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$141.25
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$74.13
Typical High
$125.89
United
Setting
Facility
Modifier
Global
Typical Low
$63.10
Median
$93.33
Typical High
$125.89
United
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$117.49
Typical High
$169.82