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Idaho 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
$794.07 / $1,764.61 / $1,764.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,263.97 / $1,335.63 / $1,335.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $975.01 / $1,375.70
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.04 / $1,419.53 / $2,015.23
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,813.71 / $1,914.47 / $2,015.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,505.52 / $1,813.71
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,764.61 / $1,968.00 / $2,952.00
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,410.66 / $1,461.12 / $2,115.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.78 / $911.97 / $1,408.11