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

Missouri 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 $132 · 10th–90th $79$2570%20%10th90th$132Professionalmedian $81 · 10th–90th $39$2090%20%10th90th$81$0.2$1.0$5.0$20.0$100.0$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
Facility
Modifier
Global
Typical Low
$79.43
Median
$79.43
Typical High
$91.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$83.18
Typical High
$257.04
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$467.74
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$199.53
BCBS
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$134.90
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
Medica
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$125.89
Typical High
$575.44
Medica
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$104.71
Typical High
$891.25
United
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$109.65
Typical High
$141.25
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$104.71
Typical High
$158.49