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Tennessee rates for HCPCS L4000

Replace girdle for spinal orthosis (cervical-thoracic-lumbar-sacral orthosis (CTLSO) or spinal orthosis SO)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $724.44 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $758.58 / $1,288.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,174.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $660.69 / $891.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,120.11 / $9,120.11 / $9,120.11
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,120.11 / $10,715.19 / $10,715.19
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $707.95 / $954.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $724.44 / $1,023.29