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Tennessee rates for HCPCS L3925

Finger orthosis (FO), proximal interphalangeal (PIP)/distal interphalangeal (DIP), nontorsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.20 / $26.20 / $28.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.72 / $27.66 / $50.99
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.39 / $47.39 / $47.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.70 / $52.41 / $52.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.61 / $36.61 / $36.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.73 / $26.73 / $36.61
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.36 / $286.64 / $334.02
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.63 / $338.63 / $408.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.37 / $28.45 / $41.54