go back

Massachusetts 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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.00 / $72.00 / $72.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $72.00 / $102.15
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$136.12 / $580.79 / $580.79
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.48 / $129.63 / $167.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $52.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.08 / $52.17 / $151.88
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.49 / $168.49 / $176.91
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.77 / $232.77 / $232.77
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$256.69 / $580.79 / $580.79
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.48 / $103.82 / $169.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.48 / $103.82 / $170.81