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Minnesota 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
$1,445.44 / $1,445.44 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,122.02 / $1,698.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,041.74 / $3,019.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,041.74 / $2,041.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $7,762.47 / $18,620.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,754.23 / $3,019.95
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $7,762.47 / $14,454.40
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $2,398.83 / $3,235.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $2,041.74 / $9,549.93
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $912.01 / $2,238.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.79 / $912.01 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,023.29 / $2,570.40