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Sacroiliac Orthosis, Flexible, Off-the-Shelf

Michigan 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?

$63.10

Typical negotiated rate. In Michigan, October 2026.

Insurers have agreed to pay about $63.10 for this service. The price depends on where it is billed: about $63.10 from a physician practice, and about $123 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 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$63.10$46.77 to $75.86
FacilityA hospital or hospital-owned outpatient department$123$67.61 to $209

How much rates vary

Facilitymedian $123 · 10th to 90th $66 to $275Professionalmedian $63 · 10th to 90th $37 to $98
$50$100$200$500facility $123professional $63

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$36.31
Median
$63.10
Typical High
$63.10
Aetna
Setting
Professional
Modifier
None
Typical Low
$36.31
Median
$36.31
Typical High
$66.07
BCBS Michigan
Setting
Facility
Modifier
None
Typical Low
$75.86
Median
$186.21
Typical High
$354.81
BCBS Michigan
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$63.10
Typical High
$63.10
BCBS Michigan
Setting
Professional
Modifier
RR · Rental
Typical Low
$63.10
Median
$63.10
Typical High
$63.10
CareSource
Setting
Facility
Modifier
None
Typical Low
$48.98
Median
$48.98
Typical High
$48.98
Cigna
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$74.13
Cigna
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$67.61
Typical High
$112.20
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$42.66
Median
$204.17
Typical High
$218.78
Health Alliance Plan
Setting
Professional
Modifier
None
Typical Low
$42.66
Median
$75.86
Typical High
$97.72
Priority Health
Setting
Facility
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$74.13
Priority Health
Setting
Professional
Modifier
None
Typical Low
$48.98
Median
$67.61
Typical High
$117.49
United
Setting
Facility
Modifier
None
Typical Low
$107.15
Median
$128.82
Typical High
$151.36
United
Setting
Professional
Modifier
None
Typical Low
$43.65
Median
$51.29
Typical High
$74.13

Where Michigan 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.

Michigan· 27th of 51

$63.10

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.