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Indiana 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
$1,021.91 / $1,021.91 / $2,064.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$982.61 / $1,025.68 / $1,108.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,631.12 / $1,847.92 / $2,064.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,007.23 / $1,123.35 / $1,516.53
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,556.89 / $2,271.17 / $3,097.07
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.00 / $2,271.17 / $2,787.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $1,335.63 / $2,064.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $1,335.63 / $2,117.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.45 / $996.86 / $1,386.43