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Tennessee 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

Facilitymedian $71 · 10th–90th $40–$1000%20%40%10th90th$71Professionalmedian $40 · 10th–90th $40–$400%50%$40$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $331.13 / $331.13
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00