go back

New York 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 / $39.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $125.89 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $70.79 / $53,703.18
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $213.80 / $38,018.94
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $223.87
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $50,118.72 / $75,857.76
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
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $257.04
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80