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Florida 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
$28.00 / $40.00 / $40.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.00 / $40.00 / $40.00
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99,999.99 / $99,999.99 / $99,999.99
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$300.00 / $99,999.99 / $99,999.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.55 / $259.32 / $285.25
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$259.32 / $259.32 / $259.32