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

Utah 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 October 2026.

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

$64.57

Typical negotiated rate. In Utah, October 2026.

Insurers have agreed to pay about $64.57 for this service. The price depends on where it is billed: about $63.10 from a physician practice, and about $72.44 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$63.10$52.48 to $93.33
FacilityA hospital or hospital-owned outpatient department$72.44$72.44 to $87.10

How much rates vary

Facilitymedian $72 · 10th to 90th $52 to $115Professionalmedian $63 · 10th to 90th $38 to $95
$50$100$200facility $72professional $63

Distribution of negotiated rates across all payers (price axis is log-scale). 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
None
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Aetna
Setting
Professional
Modifier
None
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Cigna
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$52.48
Typical High
$56.23
Cigna
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
Molina
Setting
Professional
Modifier
None
Typical Low
$39.81
Median
$47.86
Typical High
$61.66
Regence BlueShield
Setting
Facility
Modifier
None
Typical Low
$85.11
Median
$87.10
Typical High
$199.53
Regence BlueShield
Setting
Professional
Modifier
None
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
Select Health
Setting
Facility
Modifier
None
Typical Low
$89.13
Median
$89.13
Typical High
$89.13
Select Health
Setting
Professional
Modifier
None
Typical Low
$44.67
Median
$169.82
Typical High
$177.83
U of Utah Health Plan
Setting
Professional
Modifier
None
Typical Low
$58.88
Median
$85.11
Typical High
$128.82
United
Setting
Professional
Modifier
None
Typical Low
$33.88
Median
$95.50
Typical High
$102.33

Where Utah sits

The same service costs 5.4 times more in Hawaii than in New Hampshire. 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.

Utah· 45th of 51

$64.57

HI $214NH $39.81

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.