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

Tennessee 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 $135 · 10th–90th $63$6030%20%10th90th$135Professionalmedian $78 · 10th–90th $69$1450%20%40%10th90th$78$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
Facility
Modifier
Global
Typical Low
$75.86
Median
$83.18
Typical High
$134.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$75.86
Typical High
$134.90
BCBS
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$134.90
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$63.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$602.56
Typical High
$602.56
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$891.25
Typical High
$891.25
United
Setting
Facility
Modifier
Global
Typical Low
$77.62
Median
$109.65
Typical High
$158.49
United
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$107.15
Typical High
$147.91