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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 October 2026.

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

$83.18

Typical negotiated rate. In Missouri, October 2026.

Insurers have agreed to pay about $83.18 for this service. The price depends on where it is billed: about $81.28 from a physician practice, and about $135 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$81.28$39.81 to $105
FacilityA hospital or hospital-owned outpatient department$135$79.43 to $575

How much rates vary

Facilitymedian $135 · 10th to 90th $52 to $575Professionalmedian $81 · 10th to 90th $38 to $209
$50$100$200$500$1Kfacility $135professional $81

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
$79.43
Median
$79.43
Typical High
$91.20
Aetna
Setting
Professional
Modifier
None
Typical Low
$72.44
Median
$79.43
Typical High
$91.20
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$134.90
Typical High
$616.60
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$38.90
Median
$39.81
Typical High
$158.49
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$29.51
Median
$29.51
Typical High
$107.15
BCBS Kansas City
Setting
Professional
Modifier
None
Typical Low
$81.28
Median
$81.28
Typical High
$134.90
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
Medica
Setting
Facility
Modifier
None
Typical Low
$75.86
Median
$208.93
Typical High
$575.44
Medica
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$104.71
Typical High
$891.25
United
Setting
Facility
Modifier
None
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
United
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$104.71
Typical High
$158.49
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Anthem BCBS
Setting
Professional
Modifier
RR · Rental
Typical Low
$8.51
Median
$39.81
Typical High
$39.81

Where Missouri 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.

Missouri· 34th of 51

$83.18

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.