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

Virginia 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 $138 · 10th–90th $79$2290%50%10th90th$138Professionalmedian $74 · 10th–90th $39$1700%10%20%10th90th$74$0.2$2.0$20.0$200.0$2.0K

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
$57.54
Median
$169.82
Typical High
$169.82
Aetna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$85.11
Typical High
$169.82
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$144.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$81.28
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$77.62
Median
$77.62
Typical High
$81.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$102.33
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$38.02
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$131.83
Typical High
$208.93
Medcost
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$107.15
Typical High
$194.98
Medcost
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$169.82
Sentara
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$177.83
Typical High
$10,000.00
Sentara
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$177.83
Typical High
$10,000.00
United
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$93.33
Typical High
$213.80
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$104.71
Typical High
$169.82