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

Michigan 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?

$93.33

Typical negotiated rate. In Michigan, October 2026.

Insurers have agreed to pay about $93.33 for this service. The price depends on where it is billed: about $93.33 from a physician practice, and about $166 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$93.33$52.48 to $112
FacilityA hospital or hospital-owned outpatient department$166$52.48 to $355

How much rates vary

Facilitymedian $166 · 10th to 90th $52 to $501Professionalmedian $93 · 10th to 90th $25 to $141
$20$50$100$200$500$1Kfacility $166professional $93

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
$66.07
Median
$112.20
Typical High
$112.20
Aetna
Setting
Professional
Modifier
None
Typical Low
$66.07
Median
$66.07
Typical High
$112.20
BCBS Michigan
Setting
Facility
Modifier
None
Typical Low
$138.04
Median
$338.84
Typical High
$630.96
BCBS Michigan
Setting
Professional
Modifier
None
Typical Low
$107.15
Median
$112.20
Typical High
$112.20
BCBS Michigan
Setting
Professional
Modifier
RR · Rental
Typical Low
$112.20
Median
$112.20
Typical High
$112.20
CareSource
Setting
Facility
Modifier
None
Typical Low
$87.10
Median
$87.10
Typical High
$87.10
Cigna
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Cigna
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$52.48
Typical High
$56.23
Health Alliance Plan
Setting
Facility
Modifier
None
Typical Low
$53.70
Median
$63.10
Typical High
$79.43
Health Alliance Plan
Setting
Professional
Modifier
None
Typical Low
$21.88
Median
$35.48
Typical High
$123.03
Priority Health
Setting
Facility
Modifier
None
Typical Low
$52.48
Median
$52.48
Typical High
$52.48
Priority Health
Setting
Professional
Modifier
None
Typical Low
$38.02
Median
$52.48
Typical High
$177.83
United
Setting
Facility
Modifier
None
Typical Low
$181.97
Median
$213.80
Typical High
$257.04
United
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$104.71
Typical High
$165.96

Where Michigan 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.

Michigan· 29th of 51

$93.33

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.