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

Ohio 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?

$123

Typical negotiated rate. In Ohio, July 2026.

Insurers have agreed to pay about $123 for this service. The price depends on where it is billed: about $129 from a physician practice, and about $123 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 8 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$129$69.18 to $219
FacilityA hospital or hospital-owned outpatient department$123$117 to $145

How much rates vary

Facilitymedian $123 · 10th to 90th $60 to $204Professionalmedian $129 · 10th to 90th $40 to $302
$50$100$200$500facility $123professional $129

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
$60.26
Median
$120.23
Typical High
$144.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$72.44
Typical High
$107.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$123.03
Typical High
$251.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$204.17
Typical High
$346.74
CareSource
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$112.20
Typical High
$158.49
CareSource
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$120.23
Typical High
$181.97
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$57.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$56.23
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$54.95
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$38.02
Molina
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$53.70
Typical High
$77.62
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$194.98
Typical High
$354.81
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$109.65
Typical High
$181.97
United
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$104.71
Typical High
$158.49

Where Ohio 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.

Ohio· 6th of 51

$123

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.