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Sacroiliac Orthosis, Flexible, Off-the-Shelf

West Virginia rates for HCPCS L0621

Sacroiliac orthosis (SO), flexible, provides pelvic-sacral support, 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, Flexible, Off-the-Shelf cost?

$51.29

Typical negotiated rate. In West Virginia, October 2026.

Insurers have agreed to pay about $51.29 for this service. The price depends on where it is billed: about $51.29 from a physician practice, and about $67.61 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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$51.29$46.77 to $69.18
FacilityA hospital or hospital-owned outpatient department$67.61$67.61 to $105

How much rates vary

Facilitymedian $68 · 10th to 90th $68 to $105Professionalmedian $51 · 10th to 90th $46 to $115
$50$100$200facility $68professional $51

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
Professional
Modifier
None
Typical Low
$35.48
Median
$45.71
Typical High
$45.71
CareSource
Setting
Facility
Modifier
None
Typical Low
$48.98
Median
$48.98
Typical High
$48.98
CareSource
Setting
Professional
Modifier
None
Typical Low
$52.48
Median
$52.48
Typical High
$89.13
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$104.71
Cigna
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$48.98
Typical High
$346.74
United
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$107.15
Typical High
$107.15
United
Setting
Professional
Modifier
None
Typical Low
$46.77
Median
$58.88
Typical High
$114.82

Where West Virginia sits

The same service costs 3.6 times more in Hawaii than in Utah. 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.

West Virginia· 39th of 51

$51.29

HI $129UT $35.48

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.