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Sacroiliac Orthosis, Rigid or Semi-Rigid, Custom Fabricated

New York rates for HCPCS L0624

Sacroiliac orthosis (SO), provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated

Rates data updated July 2026.

How much does Sacroiliac Orthosis, Rigid or Semi-Rigid, Custom Fabricated cost?

$39.81

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $39.81 for this service. The price depends on where it is billed: about $39.81 from a physician practice, and about $39.81 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 8 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$39.81$39.81 to $126
FacilityA hospital or hospital-owned outpatient department$39.81$39.81 to $214

How much rates vary

Facilitymedian $40 · 10th to 90th $40 to $214Professionalmedian $40 · 10th to 90th $40 to $170
$100$1K$10Kfacility $40professional $40

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
$39.81
Median
$39.81
Typical High
$39.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$213.80
Typical High
$213.80
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$223.87
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$50,118.72
Typical High
$75,857.76
United
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$229.09
United
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$60.26
Typical High
$213.80
Univera
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$257.04
Univera
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80

Where New York sits

The same service costs 3.0 times more in California than in Minnesota. 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.

New York· 47th of 51

$39.81

CA $110MN $37.15

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.