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North Carolina rates for HCPCS L0624

Sacroiliac Orthosis 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
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.60 / $49.76 / $60.00
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $48.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.00 / $90.00 / $100.00