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Tennessee rates for HCPCS L3995

Addition to upper extremity orthosis, sock, fracture or equal, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.97 / $16.97 / $18.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.64 / $19.38 / $31.76
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.60 / $69.75 / $69.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.47 / $33.93 / $33.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$19.27 / $29.97 / $29.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $29.97
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.00 / $196.70 / $199.55
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$232.65 / $232.65 / $360.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.54 / $18.43 / $26.90