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Virginia 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
$735.94 / $889.07 / $889.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.94 / $889.07 / $989.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,798.13 / $1,798.13 / $1,909.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,002.36 / $1,002.36 / $1,280.49
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.60 / $1,148.60 / $1,148.60
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 / $750.72 / $1,028.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.69 / $1,618.32 / $2,157.76
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.05 / $1,040.21 / $2,009.12
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,355.41 / $2,247.66 / $2,995.11
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$985.15 / $1,393.42 / $2,297.23
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$985.15 / $1,393.42 / $2,297.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.52 / $897.07 / $1,347.85