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

South Dakota 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?

$132

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $132 for this service. The price depends on where it is billed: about $132 from a physician practice, and about $141 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 7 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$132$107 to $158
FacilityA hospital or hospital-owned outpatient department$141$120 to $195

How much rates vary

Facilitymedian $141 · 10th to 90th $83 to $263Professionalmedian $132 · 10th to 90th $95 to $191
$50$100$200$500facility $141professional $132

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$158.49
Typical High
$158.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$109.65
Typical High
$120.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$194.98
Cigna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$190.55
Medica
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$131.83
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$144.54
Typical High
$891.25
Midlands
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$194.98
Midlands
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Midlands
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$147.91
Typical High
$173.78
United
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$22.91
Median
$134.90
Typical High
$177.83
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78

Where South Dakota 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.

South Dakota· 5th of 51

$132

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.