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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
$87.44 / $87.44 / $95.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.08 / $89.06 / $163.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.80 / $174.92 / $174.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.05 / $119.29 / $119.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.08 / $87.08 / $119.29
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.43 / $980.51 / $986.48
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,118.57 / $1,145.39 / $1,431.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.64 / $95.24 / $143.46