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Alaska rates for HCPCS L3976

Shoulder-elbow-wrist-hand-finger orthosis (SEWHO), abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,540.34 / $1,540.34 / $1,540.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.38 / $1,028.38 / $1,028.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.72 / $1,028.38 / $1,059.23
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.05 / $530.05 / $530.05
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,708.22 / $1,708.22 / $2,697.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.05 / $530.05 / $1,028.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.72 / $1,059.23 / $2,107.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$869.08 / $1,719.39 / $2,242.67