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

Montana 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?

$112

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $112 for this service. The price depends on where it is billed: about $100 from a physician practice, and about $182 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 5 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$100$93.33 to $182
FacilityA hospital or hospital-owned outpatient department$182$112 to $5,129

How much rates vary

Facilitymedian $182 · 10th to 90th $89 to $5,248Professionalmedian $100 · 10th to 90th $79 to $182
$50$100$200$500$1K$2K$5Kfacility $182professional $100

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
Professional
Modifier
None
Typical Low
$34.67
Median
$77.62
Typical High
$125.89
Cigna
Setting
Facility
Modifier
None
Typical Low
$169.82
Median
$181.97
Typical High
$181.97
Cigna
Setting
Professional
Modifier
None
Typical Low
$181.97
Median
$181.97
Typical High
$181.97
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$89.13
Median
$173.78
Typical High
$5,623.41
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$89.13
Median
$112.20
Typical High
$5,495.41
Providence
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$181.97
Typical High
$181.97
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$100.00
Typical High
$181.97
United
Setting
Professional
Modifier
None
Typical Low
$93.33
Median
$95.50
Typical High
$158.49

Where Montana 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.

Montana· 16th of 51

$112

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.