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Tennessee rates for HCPCS L1630

Hip orthosis (HO), abduction control of hip joints, semi-flexible (Von Rosen type), custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $95.50 / $151.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $95.50 / $169.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $144.54 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.10 / $87.10 / $120.23
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,445.44 / $1,445.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.26 / $93.33 / $120.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $95.50 / $134.90