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Tennessee rates for HCPCS L3967

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$983.89 / $983.89 / $1,074.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$923.88 / $1,014.85 / $1,841.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,302.98 / $1,968.23 / $1,968.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,540.39 / $1,540.39 / $1,540.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.48 / $1,124.48 / $1,540.39
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,417.06 / $10,128.96 / $10,128.96
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,951.02 / $10,951.02 / $15,922.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.35 / $1,050.18 / $1,460.26