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Arizona 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
$806.09 / $1,027.43 / $1,817.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$529.07 / $1,911.27 / $3,455.50
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,322.68 / $1,763.57 / $2,402.86
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 / $2,393.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.04 / $1,152.71 / $9,614.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$830.84 / $920.18 / $1,386.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.67 / $920.18 / $1,386.11