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New Hampshire 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
$1,134.71 / $1,134.71 / $1,361.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$829.37 / $880.51 / $1,134.71
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,015.23 / $2,015.23 / $2,388.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,123.35 / $1,123.35 / $1,177.02
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,631.65 / $1,631.65 / $5,036.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.25 / $1,005.38 / $1,193.75
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,509.34 / $1,660.27 / $2,113.08