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

South Carolina 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 $87 · 10th–90th $74$1780%20%10th90th$87Professionalmedian $79 · 10th–90th $50$1660%20%10th90th$79$50.0$100.0$200.0$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
Facility
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$77.62
Typical High
$144.54
BCBS
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$177.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$223.87
Typical High
$331.13
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
$181.97
Medcost
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$102.33
Typical High
$208.93
Medcost
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$72.44
Molina
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$117.49
Typical High
$213.80
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$107.15
Typical High
$158.49