go back

North Dakota 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
$1,518.62 / $1,518.62 / $1,518.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,434.61 / $1,434.61 / $1,518.62
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,951.64 / $2,307.53 / $2,364.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,393.63 / $2,417.56 / $3,039.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$611.87 / $1,518.62 / $9,614.69
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.57 / $1,021.58 / $1,663.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.45 / $1,021.58 / $1,663.13