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Tennessee rates for HCPCS L3765

Elbow-wrist-hand-finger orthosis (EWHFO), 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
$635.99 / $635.99 / $694.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$597.20 / $655.99 / $1,190.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$842.26 / $1,272.27 / $1,272.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.46 / $907.46 / $907.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.45 / $662.45 / $907.46
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,208.80 / $6,547.41 / $6,547.41
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$7,078.87 / $7,078.87 / $10,292.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$470.16 / $678.84 / $958.90