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Arizona 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
Professional
Modifier
Low / Median / High Price
$806.09 / $1,027.43 / $1,817.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$483.66 / $1,747.21 / $3,158.88
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,209.14 / $1,612.18 / $2,196.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $1,335.63 / $1,335.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $975.01 / $2,393.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.04 / $1,152.71 / $9,614.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$830.84 / $920.18 / $1,386.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$830.84 / $920.18 / $1,386.11