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

New Hampshire 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?

$39.81

Typical negotiated rate. In New Hampshire, October 2026.

Insurers have agreed to pay about $39.81 for this service. The price depends on where it is billed: about $39.81 from a physician practice, and about $138 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$39.81$38.90 to $105
FacilityA hospital or hospital-owned outpatient department$138$126 to $148

How much rates vary

Facilitymedian $138 · 10th to 90th $52 to $166Professionalmedian $40 · 10th to 90th $38 to $135
$50$100$200facility $138professional $40

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$147.91
Typical High
$169.82
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$38.90
Median
$39.81
Typical High
$39.81
Anthem BCBS
Setting
Professional
Modifier
UE · Used equipment
Typical Low
$29.51
Median
$29.51
Typical High
$29.51
Cigna
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$52.48
Typical High
$56.23
Cigna
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$117.49
Typical High
$194.98
United
Setting
Professional
Modifier
None
Typical Low
$69.18
Median
$104.71
Typical High
$169.82
Well Sense
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$134.90
Typical High
$134.90

Where New Hampshire 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.

New Hampshire· 51st of 51

$39.81

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.