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Alaska 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
Professional
Modifier
Low / Median / High Price
$1,726.32 / $1,726.32 / $1,726.32
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 / $1,335.63 / $1,375.70
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.04 / $594.04 / $594.04
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,914.47 / $1,914.47 / $3,022.85
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.04 / $594.04 / $1,335.63
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $1,375.70 / $2,361.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$974.00 / $1,926.97 / $2,513.44