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Tennessee rates for HCPCS L3905

Wrist-hand orthosis (WHO), 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
$489.78 / $537.03 / $851.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $524.81 / $933.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $812.83 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $602.56
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $5,011.87 / $5,011.87
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,495.41 / $7,943.28 / $7,943.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $478.63 / $776.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $512.86 / $645.65