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Washington, DC 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
$831.76 / $831.76 / $831.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $933.25 / $1,230.27
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $1,380.38
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,884.03 / $3,981.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $3,019.95 / $3,019.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $1,000.00 / $1,862.09