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

New Mexico 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 $79 · 10th–90th $29$1410%10%20%10th90th$79Professionalmedian $78 · 10th–90th $50$1910%20%10th90th$78$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$77.62
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$194.98
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$125.89
Typical High
$190.55
Providence
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$66.07
Typical High
$109.65
Providence
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$102.33
United
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$109.65
Typical High
$213.80
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$95.50
Typical High
$158.49