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Mississippi 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
$1,163.32 / $1,163.32 / $1,854.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.78 / $1,326.91 / $1,854.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,608.63 / $1,608.63 / $1,608.63
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,608.63 / $1,608.63 / $1,608.63
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.45 / $985.49 / $1,545.89