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Tennessee rates for HCPCS L0621

Sacroiliac Orthosis Flexible Provides Pelvic- Sacral Support Reduces Motion About The Sacro- Iliac Joint Includes Straps Closures May Include Pendulous Abdomen Design Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.44 / $41.44 / $45.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.15 / $43.74 / $72.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.36 / $82.13 / $85.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.53 / $67.20 / $77.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.06 / $49.06 / $67.20
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.71 / $324.51 / $324.51
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.47 / $539.41 / $539.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.93 / $51.64 / $74.34