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Tennessee rates for HCPCS L3702

Elbow orthosis (EO), without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $154.88 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $154.88 / $288.40
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $239.88 / $257.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $128.82 / $177.83
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $1,479.11
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,344.23 / $2,344.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.13 / $141.25 / $223.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $151.36 / $204.17