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Arizona 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
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15.49 / $35.48 / $74.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $60.26 / $112.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $85.11
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $229.09 / $229.09