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Tennessee rates for HCPCS L3975

Shoulder-elbow-wrist-hand-finger orthosis (SEWHO), shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$833.34 / $833.34 / $910.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.51 / $859.54 / $1,559.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,103.60 / $1,667.05 / $1,667.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.78 / $1,191.78 / $1,191.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $870.00 / $1,191.78
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,894.19 / $8,579.00 / $8,579.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,275.29 / $9,275.29 / $13,485.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.05 / $885.51 / $1,235.58