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Ohio 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 / $74.13
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
$58.88 / $75.86 / $125.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $50.12 / $60.26
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $75.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,000.00