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

New York 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.

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

$75.86

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $75.86 for this service. The price depends on where it is billed: about $72.44 from a physician practice, and about $120 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 9 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$72.44$39.81 to $117
FacilityA hospital or hospital-owned outpatient department$120$77.62 to $214

How much rates vary

Facilitymedian $120 · 10th to 90th $72 to $229Professionalmedian $72 · 10th to 90th $40 to $204
$100$1K$10Kfacility $120professional $72

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$162.18
Aetna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$72.44
Typical High
$120.23
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$239.88
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$234.42
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$151.36
Typical High
$151.36
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$199.53
Typical High
$457.09
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$144.54
Typical High
$229.09
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$223.87
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$97.72
Typical High
$213.80
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$114.82
Typical High
$208.93
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$117.49
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$117.49
Typical High
$208.93
Univera
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$85.11
Typical High
$223.87
Univera
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$97.72
Typical High
$213.80

Where New York sits

The same service costs 3.9 times more in Hawaii than in California. 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 York· 31st of 51

$75.86

HI $204CA $52.48

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.