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

North Dakota 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 $158 · 10th–90th $107$1950%50%10th90th$158Professionalmedian $145 · 10th–90th $83$1620%20%10th90th$145$50.0$100.0$200.0$500.0$1.0K

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
$107.15
Median
$158.49
Typical High
$158.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$107.15
Typical High
$223.87
BCBS
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$144.54
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$151.36
Typical High
$190.55
Medica
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$158.49
Typical High
$467.74
Medica
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$107.15
Typical High
$234.42
United
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$134.90
Typical High
$181.97