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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.

How much does Sacroiliac Orthosis, Rigid or Semi-Rigid, Off-the-Shelf cost?

$77.62

Typical negotiated rate. In Tennessee, July 2026.

Insurers have agreed to pay about $77.62 for this service. The price depends on where it is billed: about $77.62 from a physician practice, and about $135 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 5 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$77.62$74.13 to $107
FacilityA hospital or hospital-owned outpatient department$135$83.18 to $603

How much rates vary

Facilitymedian $135 · 10th to 90th $63 to $603Professionalmedian $78 · 10th to 90th $69 to $145
$50$100$200$500$1Kfacility $135professional $78

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. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

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

Where Tennessee 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.

Tennessee· 28th of 51

$77.62

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.