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Massachusetts 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
$880.51 / $880.51 / $880.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.51 / $970.54 / $1,290.68
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,803.04 / $5,740.66 / $9,614.69
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$835.51 / $1,497.00 / $1,968.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,200.40 / $2,602.29 / $3,351.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,319.58 / $1,553.57 / $1,553.57
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 / $1,335.63 / $2,393.63
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,631.65 / $1,631.65 / $1,713.23
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,534.44 / $1,534.44 / $1,534.44
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,191.35 / $9,614.69 / $9,614.69
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.82 / $1,005.38 / $1,968.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.88 / $1,077.21 / $1,968.00