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

Mississippi 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 $83 · 10th–90th $79$2140%50%10th90th$83Professionalmedian $79 · 10th–90th $52$1260%10%20%10th90th$79$50.0$100.0$200.0

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
$120.23
Aetna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$79.43
Typical High
$125.89
BCBS
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$83.18
BCBS
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$83.18
Typical High
$83.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$134.90
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$107.15
Typical High
$165.96