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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 October 2026.

How much does Sacroiliac Orthosis, Rigid or Semi-Rigid, Off-the-Shelf cost?

$105

Typical negotiated rate. In West Virginia, October 2026.

Insurers have agreed to pay about $105 for this service. The price depends on where it is billed: about $105 from a physician practice, and about $52.48 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$105$77.62 to $162
FacilityA hospital or hospital-owned outpatient department$52.48$52.48 to $87.10

How much rates vary

Facilitymedian $52 · 10th to 90th $52 to $182Professionalmedian $105 · 10th to 90th $38 to $257
$50$100$200$500facility $52professional $105

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
$85.11
Median
$85.11
Typical High
$85.11
CareSource
Setting
Facility
Modifier
None
Typical Low
$87.10
Median
$87.10
Typical High
$87.10
CareSource
Setting
Professional
Modifier
None
Typical Low
$93.33
Median
$93.33
Typical High
$158.49
Cigna
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$52.48
Typical High
$186.21
Cigna
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$38.02
Typical High
$616.60
United
Setting
Facility
Modifier
None
Typical Low
$181.97
Median
$181.97
Typical High
$181.97
United
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$138.04
Typical High
$257.04

Where West Virginia sits

The same service costs 5.4 times more in Hawaii than in New Hampshire. 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· 19th of 51

$105

HI $214NH $39.81

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.