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

Vermont 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 $76 · 10th–90th $52$1170%20%40%10th90th$76Professionalmedian $72 · 10th–90th $72$1070%50%90th$72$50.0$100.0$200.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$93.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$52.48
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$169.82
Typical High
$169.82
United
Setting
Facility
Modifier
Global
Typical Low
$75.86
Median
$77.62
Typical High
$117.49
United
Setting
Professional
Modifier
Global
Typical Low
$74.13
Median
$144.54
Typical High
$309.03