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Minnesota 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
$1,280.08 / $1,280.08 / $1,280.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.49 / $1,280.08 / $1,355.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,587.83 / $1,966.44 / $2,590.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,473.86 / $1,750.20 / $1,842.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.38 / $5,684.85 / $15,789.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,135.63 / $2,263.76 / $2,712.24
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,375.03 / $5,454.34 / $12,432.44
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,135.63 / $2,135.63 / $2,198.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$545.96 / $1,842.32 / $8,579.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.38 / $911.54 / $2,010.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.38 / $911.54 / $1,897.59