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Tennessee rates for HCPCS L3730

Elbow orthosis (EO), double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.28 / $472.28 / $516.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$463.54 / $516.01 / $883.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.46 / $944.78 / $944.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$531.22 / $620.97 / $620.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$453.31 / $453.31 / $620.97
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,944.09 / $5,297.15 / $6,293.94
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,629.67 / $6,788.79 / $9,720.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$349.14 / $507.37 / $746.09