HCPCS L0623 at Mary Bridge Children's Hospital

Sacroiliac orthosis, 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

Mary Bridge Children's Hospital, Tacoma

Description from CMS's HCPCS Level II code file.

What Mary Bridge Children's Hospital publishes for this code: as an outpatient

Mary Bridge Children's Hospital’s prices for HCPCS L0623, as an outpatient
Who pays	Hospital’s fee (lowest – highest)	Doctor’s fee the hospital lists
Commercial insuranceInsurer rates	$49.09 – $72618 plans	—
Medicare AdvantageInsurer rates	$59.19 – $65.117 plans	—
Cash pricePaying yourself, without insurance	$30.40	—
List priceBefore any discount; few people pay it	$76.00	—

Lowest and highest amounts Mary Bridge Children's Hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. Its price file is dated 2026-08-27. This is one line of a bill; most care brings several.

What Mary Bridge Children's Hospital publishes for this code: during a hospital stay

Mary Bridge Children's Hospital’s prices for HCPCS L0623, during a hospital stay
Who pays	Hospital’s fee (lowest – highest)	Doctor’s fee the hospital lists
Commercial insuranceInsurer rates	$49.70 – $60.806 plans	—
Cash pricePaying yourself, without insurance	$30.40	—
List priceBefore any discount; few people pay it	$76.00	—

Lowest and highest amounts Mary Bridge Children's Hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. Its price file is dated 2026-08-27. This is one line of a bill; most care brings several.

Bills to expect

The hospital’s fee is the price above. Doctors usually send their own bills. Their amounts here are what original Medicare allows in the rest of Washington for 2026, and a private-plan estimate of 118% to 179% of that (the range found across studies of what insurers pay doctors). Those are estimates, not quotes.

Bills to expect for HCPCS L0623 at Mary Bridge Children's Hospital
Bill	What it’s for	Original Medicare allows	Private plan estimate
Hospital's feeThe hospital	The service	—	The price above

Original Medicare amounts are only for people on original Medicare. Your share depends on your plan’s deductible, copay and coinsurance.

Compare HCPCS L0623 at every Washington hospital, with Medicare’s reference amounts.