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Tennessee rates for HCPCS L3960

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning, airplane design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $446.68 / $707.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $457.09 / $794.33
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $758.58
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $676.08 / $724.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $512.86
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $5,128.61
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,248.07 / $6,165.95 / $6,165.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $398.11 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $436.52 / $575.44