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North Carolina 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
$1,817.69 / $1,817.69 / $3,135.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$886.26 / $1,817.69 / $1,817.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,891.09 / $3,079.23 / $3,792.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.21 / $1,556.89 / $1,556.89
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 / $1,335.63 / $2,393.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.04 / $1,817.69 / $2,493.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,519.00 / $1,519.00 / $1,519.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,418.30 / $2,418.30 / $3,718.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.82 / $1,026.38 / $1,462.25
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,243.52 / $9,614.69 / $9,614.69
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,394.85 / $15,114.23 / $15,114.23