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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
$1,434.61 / $1,434.61 / $1,434.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$953.14 / $1,434.61 / $1,518.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,779.50 / $2,203.80 / $2,903.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,651.77 / $1,961.47 / $2,064.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $6,370.76 / $17,694.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,393.63 / $2,537.23 / $3,039.90
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,782.24 / $6,112.43 / $13,932.48
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,393.63 / $2,393.63 / $2,463.19
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$611.87 / $2,064.71 / $9,614.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.45 / $1,021.58 / $2,253.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.45 / $920.18 / $2,073.34