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

West Virginia 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 $85 · 10th–90th $85$1820%50%90th$85Professionalmedian $85 · 10th–90th $58$1700%20%10th90th$85$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
Facility
Modifier
Global
Typical Low
$85.11
Median
$85.11
Typical High
$85.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$85.11
Typical High
$169.82
CareSource
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$181.97
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$158.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$186.21
Typical High
$186.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$616.60
United
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$181.97
United
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$120.23
Typical High
$190.55