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Tennessee rates for HCPCS L3201

Orthopedic shoe, Oxford with supinator or pronator, infant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.82 / $17.82 / $19.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.48 / $18.80 / $31.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.06 / $30.06 / $41.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.94 / $21.94 / $30.06
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $187.60 / $194.47
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$249.13 / $259.10 / $299.85
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.30 / $20.59 / $36.50