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South Carolina 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
$912.01 / $912.01 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $954.99 / $1,621.81
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $1,995.26 / $2,570.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $2,951.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $2,137.96
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $933.25 / $1,202.26
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,348.96 / $2,951.21
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $1,258.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.32 / $1,023.29 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $912.01 / $1,174.90