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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
$870.96 / $870.96 / $870.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,023.29 / $1,862.09
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $1,949.84 / $9,549.93
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,548.82 / $2,089.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,630.27 / $3,467.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,548.82 / $1,548.82
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 / $1,348.96
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $1,778.28 / $2,691.53
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,548.82
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $1,949.84 / $9,549.93
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,548.82 / $2,290.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.48 / $1,071.52 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,174.90 / $1,778.28