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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
$758.58 / $977.24 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,023.29
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,737.80 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,023.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $1,258.93 / $3,715.35