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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 October 2026.

How much does Sacroiliac Orthosis, Rigid or Semi-Rigid, Off-the-Shelf cost?

$100

Typical negotiated rate. In New Jersey, October 2026.

Insurers have agreed to pay about $100 for this service. The price depends on where it is billed: about $100 from a physician practice, and about $52.48 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$100$72.44 to $174
FacilityA hospital or hospital-owned outpatient department$52.48$52.48 to $72.44

How much rates vary

Facilitymedian $52 · 10th to 90th $52 to $120Professionalmedian $100 · 10th to 90th $38 to $174
$50$100$200facility $52professional $100

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
Facility
Modifier
None
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Aetna
Setting
Professional
Modifier
None
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Cigna
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$52.48
Typical High
$120.23
Cigna
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
Emblem Health
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$158.49
Typical High
$158.49
Horizon BCBS
Setting
Professional
Modifier
None
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
Horizon BCBS
Setting
Professional
Modifier
RR · Rental
Typical Low
$17.38
Median
$17.38
Typical High
$17.38
United
Setting
Facility
Modifier
None
Typical Low
$181.97
Median
$181.97
Typical High
$213.80
United
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$104.71
Typical High
$169.82

Where New Jersey 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 Jersey· 22nd of 51

$100

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.