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Tennessee rates for HCPCS L0623

Sacroiliac orthosis (SO), provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.62 / $76.62 / $83.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $76.62 / $96.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.21 / $156.56 / $156.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.17 / $52.17 / $143.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.08 / $38.08 / $52.17
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.42 / $580.79 / $580.79
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$886.50 / $888.53 / $888.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.31 / $106.01 / $156.97