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Tennessee rates for HCPCS L3650

Shoulder orthosis (SO), figure of eight design abduction restrainer, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.69 / $29.69 / $453.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.14 / $33.25 / $55.57
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.49 / $49.49 / $49.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.32 / $59.39 / $59.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.94 / $46.70 / $69.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $34.09 / $46.70
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.88 / $352.17 / $414.11
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.75 / $435.96 / $563.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.95 / $32.33 / $48.33