go back

Connecticut 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
$979.46 / $979.46 / $979.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.99 / $963.30 / $985.81
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,561.80 / $2,015.23 / $2,305.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.35 / $1,123.35 / $1,177.02
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 / $1,335.63
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,309.90 / $1,309.90 / $1,309.90
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,309.90 / $1,309.90 / $1,854.01
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,534.44 / $1,534.44 / $1,534.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.24 / $1,005.38 / $1,940.73