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

Rhode Island 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 $275 · 10th–90th $93$3470%20%10th90th$275Professionalmedian $72 · 10th–90th $72$1380%50%90th$72$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
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$79.43
BCBS
Setting
Facility
Modifier
Global
Typical Low
$263.03
Median
$295.12
Typical High
$389.05
BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$117.49
Typical High
$131.83
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
United
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$125.89
Typical High
$213.80
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$138.04
Typical High
$169.82