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

New Jersey 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 $72 · 10th–90th $72$1200%50%90th$72Professionalmedian $72 · 10th–90th $46$1740%20%10th90th$72$50.0$100.0$200.0$500.0

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
$72.44
Median
$72.44
Typical High
$72.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$72.44
Typical High
$95.50
Cigna
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$52.48
Typical High
$120.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$125.89
Typical High
$158.49
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$173.78
Typical High
$173.78
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$120.23
Typical High
$173.78
United
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$104.71
Typical High
$169.82