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Nationwide 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 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $120.23 / $302.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $125.89 / $177.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $331.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $245.47 / $691.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $229.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00