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Maryland 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
Professional
Modifier
Low / Median / High Price
$824.80 / $880.51 / $1,575.37
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,287.28 / $1,287.28 / $1,377.60
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 / $975.01 / $1,335.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,410.66 / $2,015.23 / $2,901.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.67 / $1,005.38 / $1,602.56
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.01 / $1,105.01 / $1,410.66