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Tennessee rates for HCPCS L0622

Sacroiliac orthosis (SO), flexible, provides pelvic-sacral support, 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
$131.78 / $131.78 / $143.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$129.34 / $135.07 / $246.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.51 / $263.61 / $263.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.58 / $181.86 / $181.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.76 / $132.76 / $181.86
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$496.74 / $1,549.83 / $1,843.29
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,979.55 / $2,027.07 / $2,182.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$98.33 / $143.90 / $174.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.42 / $143.07 / $218.50