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Massachusetts rates for HCPCS L0624

Sacroiliac orthosis (SO), provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $100.00 / $818.35
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
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
$90.00 / $100.00 / $100.00