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Washington 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
$39.81 / $39.81 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $50.12 / $75.86