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Nebraska 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
$1,310.23 / $1,310.23 / $1,310.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,310.23 / $1,310.23 / $1,701.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,805.77 / $1,986.34 / $2,006.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $2,260.02 / $2,260.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,335.63 / $2,260.02 / $3,484.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,034.43 / $2,248.91 / $9,614.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$708.98 / $1,025.00 / $1,608.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,253.41 / $2,260.02 / $2,847.55
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,017.00 / $2,670.93 / $4,656.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$708.98 / $1,025.00 / $1,384.73