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

Nebraska 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?

$126

Typical negotiated rate. In Nebraska, October 2026.

Insurers have agreed to pay about $126 for this service. The price depends on where it is billed: about $110 from a physician practice, and about $186 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$110$95.50 to $191
FacilityA hospital or hospital-owned outpatient department$186$166 to $195

How much rates vary

Facilitymedian $186 · 10th to 90th $85 to $575Professionalmedian $110 · 10th to 90th $71 to $240
$50$100$200$500$1Kfacility $186professional $110

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
$85.11
Median
$85.11
Typical High
$85.11
Aetna
Setting
Professional
Modifier
None
Typical Low
$74.13
Median
$85.11
Typical High
$112.20
Cigna
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$194.98
Typical High
$194.98
Cigna
Setting
Professional
Modifier
None
Typical Low
$151.36
Median
$190.55
Typical High
$363.08
Medica
Setting
Facility
Modifier
None
Typical Low
$97.72
Median
$165.96
Typical High
$575.44
Medica
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$104.71
Typical High
$173.78
Midlands
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$194.98
Typical High
$363.08
Midlands
Setting
Professional
Modifier
None
Typical Low
$257.04
Median
$363.08
Typical High
$478.63
United
Setting
Facility
Modifier
None
Typical Low
$181.97
Median
$181.97
Typical High
$181.97
United
Setting
Professional
Modifier
None
Typical Low
$54.95
Median
$104.71
Typical High
$158.49

Where Nebraska 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.

Nebraska· 10th of 51

$126

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.