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Kentucky 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
Facility
Modifier
Low / Median / High Price
$802.87 / $952.04 / $987.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$817.91 / $952.04 / $989.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,153.04 / $1,852.28 / $1,946.75
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$866.36 / $963.75 / $1,002.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,389.21 / $2,579.25 / $2,966.91
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,759.67 / $2,302.90 / $3,056.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.38 / $1,028.38 / $2,170.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.72 / $1,028.38 / $8,835.64
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.05 / $890.44 / $1,221.11