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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 October 2026.

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

$151

Typical negotiated rate. In Minnesota, October 2026.

Insurers have agreed to pay about $151 for this service. The price depends on where it is billed: about $151 from a physician practice, and about $174 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$151$107 to $178
FacilityA hospital or hospital-owned outpatient department$174$91.20 to $389

How much rates vary

Facilitymedian $174 · 10th to 90th $91 to $575Professionalmedian $151 · 10th to 90th $87 to $195
$50$100$200$500$1Kfacility $174professional $151

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
Facility
Modifier
None
Typical Low
$91.20
Median
$91.20
Typical High
$91.20
Aetna
Setting
Professional
Modifier
None
Typical Low
$83.18
Median
$91.20
Typical High
$91.20
BCBS
Setting
Facility
Modifier
None
Typical Low
$154.88
Median
$173.78
Typical High
$467.74
BCBS
Setting
Professional
Modifier
None
Typical Low
$141.25
Median
$173.78
Typical High
$177.83
Cigna
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$446.68
Typical High
$1,122.02
Cigna
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$162.18
Typical High
$194.98
Health Partners
Setting
Facility
Modifier
None
Typical Low
$288.40
Median
$457.09
Typical High
$1,071.52
Health Partners
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Medica
Setting
Facility
Modifier
None
Typical Low
$29.51
Median
$138.04
Typical High
$575.44
Medica
Setting
Professional
Modifier
None
Typical Low
$87.10
Median
$109.65
Typical High
$616.60
United
Setting
Facility
Modifier
None
Typical Low
$181.97
Median
$213.80
Typical High
$257.04
United
Setting
Professional
Modifier
None
Typical Low
$63.10
Median
$109.65
Typical High
$218.78

Where Minnesota 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.

Minnesota· 6th of 51

$151

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.