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Iowa 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
$1,434.61 / $1,434.61 / $1,518.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$829.37 / $1,107.78 / $1,854.04
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $1,335.63 / $2,260.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,335.63 / $2,393.63 / $2,992.03
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,961.47 / $2,113.67 / $2,283.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,290.68 / $2,438.84 / $9,614.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$911.97 / $1,059.16 / $2,807.13
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,253.41 / $2,260.02 / $2,802.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,850.95 / $2,640.02 / $4,318.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$911.97 / $1,025.00 / $2,635.78
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,951.83 / $1,951.83 / $1,951.83
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,541.95 / $1,951.83 / $1,951.83