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Missouri 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
Facility
Modifier
Low / Median / High Price
$1,075.56 / $1,075.56 / $1,432.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,061.22 / $1,114.67 / $1,701.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,054.56 / $2,157.29 / $9,483.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,021.19 / $1,123.35 / $1,689.93
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 / $1,375.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,027.43 / $1,672.01 / $9,614.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.36 / $1,025.00 / $2,497.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.82 / $1,025.00 / $1,631.65