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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 October 2026.

How much does Sacroiliac Orthosis, Rigid or Semi-Rigid, Off-the-Shelf cost?

$72.44

Typical negotiated rate. In Maine, October 2026.

Insurers have agreed to pay about $72.44 for this service. Most negotiated rates run $38.90 to $126.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $170 · 10th to 90th $132 to $324Professionalmedian $43 · 10th to 90th $38 to $126
$50$100$200facility $170professional $43

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$74.13
Median
$125.89
Typical High
$125.89
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$131.83
Median
$169.82
Typical High
$323.59
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$38.90
Median
$39.81
Typical High
$41.69
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$29.51
Median
$29.51
Typical High
$32.36
Cigna
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$52.48
Typical High
$56.23
Cigna
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$117.49
Typical High
$251.19
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$74.13
Median
$125.89
Typical High
$125.89
United
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$104.71
Typical High
$302.00

Where Maine sits

The same service costs 5.4 times more in Hawaii than in New Hampshire. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Maine· 42nd of 51

$72.44

HI $214NH $39.81

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.