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

Nevada 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 $35 · 10th–90th $35$780%50%90th$35Professionalmedian $72 · 10th–90th $35$1700%10%20%10th90th$72$2.0$5.0$10.0$20.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$34.67
Typical High
$34.67
Aetna
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$57.54
Typical High
$257.04
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$63.10
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$39.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$117.49
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
Hometown Health
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$60.26
Typical High
$120.23
Select Health
Setting
Facility
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$60.26
Select Health
Setting
Professional
Modifier
Global
Typical Low
$40.74
Median
$54.95
Typical High
$173.78
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$93.33
Typical High
$117.49
United
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$95.50
Typical High
$158.49