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Tennessee rates for HCPCS L3901

Wrist-hand-finger orthosis (WHFO), dynamic flexor hinge, reciprocal wrist extension/ flexion, finger flexion/extension, cable driven, custom fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$868.80 / $868.80 / $949.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.18 / $876.23 / $1,626.14
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.57 / $1,737.99 / $1,737.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$947.00 / $1,107.01 / $1,107.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.12 / $808.12 / $1,107.01
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,049.64 / $9,312.17 / $10,211.21
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,304.00 / $11,304.00 / $14,700.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.27 / $933.35 / $1,330.05