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Tennessee rates for HCPCS L3762

Elbow orthosis (EO), rigid, without joints, includes soft interface material, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.34 / $53.34 / $58.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.28 / $56.30 / $99.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.85 / $120.00 / $120.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.64 / $106.70 / $106.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.81 / $65.81 / $65.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.04 / $48.04 / $65.81
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$185.25 / $549.05 / $549.05
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.47 / $593.47 / $863.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.43 / $56.68 / $79.16