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Tennessee rates for HCPCS L3917

Hand orthosis (HO), metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.40 / $52.40 / $57.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.41 / $54.03 / $98.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.39 / $104.81 / $104.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.43 / $64.66 / $64.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.20 / $47.20 / $64.66
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $539.41 / $539.41
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.01 / $583.01 / $848.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.74 / $55.93 / $77.76