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Nebraska 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
$1,169.09 / $1,169.09 / $1,169.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,169.09 / $1,169.09 / $1,518.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,611.27 / $1,772.40 / $1,790.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.38 / $2,016.60 / $2,016.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.38 / $2,016.60 / $3,109.61
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$923.01 / $1,987.47 / $8,579.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.62 / $914.59 / $1,434.84
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,010.69 / $2,016.60 / $2,540.82
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,800.00 / $2,383.25 / $4,154.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$663.07 / $914.59 / $1,238.91