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Tennessee rates for HCPCS L3962

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning, Erb's palsy design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$425.69 / $425.69 / $465.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.08 / $425.69 / $796.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$563.76 / $851.58 / $851.58
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$422.81 / $494.25 / $494.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $360.80 / $494.25
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,478.43 / $4,154.25 / $5,009.54
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,062.27 / $5,062.27 / $5,932.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.70 / $451.01 / $594.42