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Tennessee rates for HCPCS L3763

Elbow-wrist-hand orthosis (EWHO), rigid, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.80 / $393.80 / $430.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.17 / $401.09 / $737.07
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.00 / $688.00 / $688.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.51 / $787.77 / $787.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.53 / $488.53 / $488.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.63 / $356.63 / $488.53
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,367.66 / $3,743.02 / $4,287.21
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,332.34 / $4,332.34 / $6,185.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$291.12 / $419.73 / $640.36