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Arkansas rates for HCPCS L3977

Shoulder-elbow-wrist-hand-finger orthosis (SEWHO), shoulder cap design, includes one or more nontorsion joints, elastic bands, turnbuckles, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,153.71 / $1,153.71 / $1,153.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.07 / $1,153.71 / $1,153.71
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,791.92 / $2,371.65 / $2,635.17
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,015.23 / $2,015.23 / $2,075.85
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,015.23 / $2,015.23 / $2,015.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $1,335.63 / $1,660.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $1,335.63 / $1,621.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.45 / $942.58 / $1,250.72