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Tennessee rates for HCPCS L3971

Shoulder-elbow-wrist-hand orthotic (SEWHO), shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.92 / $933.92 / $1,020.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.99 / $963.30 / $1,748.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,236.82 / $1,868.27 / $1,868.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $1,335.63 / $1,335.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $975.01 / $1,335.63
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,243.52 / $9,614.69 / $9,614.69
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,394.85 / $10,394.85 / $15,114.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.42 / $1,005.38 / $1,386.11