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

Oregon 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 $59 · 10th–90th $59$1660%50%90th$59Professionalmedian $71 · 10th–90th $52$1260%20%40%10th90th$71$0.2$1.0$5.0$20.0$100.0$500.0

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
Professional
Modifier
Global
Typical Low
$61.66
Median
$72.44
Typical High
$107.15
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
$38.02
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$128.82
Typical High
$154.88
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$67.61
Typical High
$123.03
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$64.57
Typical High
$165.96
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$58.88
Median
$58.88
Typical High
$165.96
Providence
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$67.61
Typical High
$125.89
Providence
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$63.10
Typical High
$93.33
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$57.54
Median
$93.33
Typical High
$316.23
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$66.07
Typical High
$93.33
United
Setting
Facility
Modifier
Global
Typical Low
$0.16
Median
$93.33
Typical High
$257.04
United
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$95.50
Typical High
$158.49