go back

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 July 2026.

Facilitymedian $46 · 10th–90th $46$1050%50%90th$46Professionalmedian $49 · 10th–90th $31$660%10%20%10th90th$49$50.0$100.0$200.0

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
Facility
Modifier
Global
Typical Low
$45.71
Median
$45.71
Typical High
$45.71
Aetna
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$45.71
Typical High
$63.10
CareSource
Setting
Facility
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$100.00
CareSource
Setting
Professional
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$89.13
Cigna
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$104.71
Typical High
$104.71
Cigna
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$43.65
Median
$51.29
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$54.95
Typical High
$87.10