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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 July 2026.

Facilitymedian $135 · 10th–90th $87$5750%10%20%10th90th$135Professionalmedian $74 · 10th–90th $72$1260%50%10th90th$74$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
$97.72
Median
$97.72
Typical High
$97.72
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$74.13
Typical High
$97.72
BCBS
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$125.89
Typical High
$125.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$194.98
Cigna
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$190.55
Typical High
$363.08
Medica
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$169.82
Typical High
$575.44
Medica
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$104.71
Typical High
$173.78
Midlands
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$467.74
Midlands
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Midlands
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$436.52
Typical High
$467.74
United
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$134.90
Typical High
$181.97
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$104.71
Typical High
$169.82