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Vermont 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
Professional
Modifier
Low / Median / High Price
$877.47 / $877.47 / $1,012.47
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 / $1,059.23
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.38 / $1,028.38 / $1,028.38
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.72 / $1,028.38 / $1,059.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.04 / $1,065.16 / $2,078.73