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California 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
$1,107.78 / $1,107.78 / $5,814.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.51 / $1,107.78 / $5,814.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$841.22 / $3,057.41 / $6,396.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,007.23 / $1,123.35 / $1,920.18
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $2,385.85 / $4,260.43
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $2,673.87 / $6,228.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $1,335.63 / $1,600.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $975.01 / $1,375.70
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.21 / $1,292.65 / $2,216.75
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,209.14 / $1,410.66 / $3,063.15
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,468.71 / $9,614.69 / $9,614.69
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,394.85 / $10,394.85 / $15,114.23
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,255.18 / $4,255.18 / $4,255.18
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.04 / $1,817.34 / $2,075.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $1,335.63 / $1,918.13
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,803.68 / $3,803.68 / $3,803.68
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.21 / $1,612.18 / $1,615.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.51 / $920.18 / $1,983.28