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Tennessee rates for HCPCS L3764

Elbow-wrist-hand orthosis (EWHO), includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$392.73 / $392.73 / $429.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.45 / $414.54 / $735.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$520.10 / $785.63 / $785.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$579.51 / $579.51 / $579.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.04 / $423.04 / $579.51
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,526.42 / $4,272.47 / $4,930.17
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,982.06 / $4,982.06 / $7,784.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.33 / $426.41 / $650.14