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

Minnesota 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.

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

$174

Typical negotiated rate. In Minnesota, July 2026.

Insurers have agreed to pay about $174 for this service. The price depends on where it is billed: about $174 from a physician practice, and about $380 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$174$141 to $174
FacilityA hospital or hospital-owned outpatient department$380$174 to $575

How much rates vary

Facilitymedian $380 · 10th to 90th $132 to $1,072Professionalmedian $174 · 10th to 90th $107 to $174
$50$100$200$500$1Kfacility $380professional $174

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
Aetna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$95.50
Typical High
$158.49
BCBS
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$173.78
Typical High
$467.74
BCBS
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$173.78
Typical High
$173.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$501.19
Typical High
$1,348.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$173.78
Typical High
$194.98
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$549.54
Typical High
$1,071.52
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$208.93
Medica
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$131.83
Typical High
$575.44
Medica
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$95.50
Typical High
$223.87
United
Setting
Facility
Modifier
Global
Typical Low
$1.58
Median
$93.33
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$112.20
Typical High
$218.78

Where Minnesota sits

The same service costs 3.9 times more in Hawaii than in California. 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.

Minnesota· 2nd of 51

$174

HI $204CA $52.48

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.