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Ohio 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

Facilitymedian $2,138 · 10th–90th $1,096$3,5480%20%40%10th90th$2,138Professionalmedian $1,096 · 10th–90th $871$1,8620%20%40%10th90th$1,096$2.0$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,584.89 / $1,949.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,047.13 / $1,412.54
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,238.72 / $4,466.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,230.27 / $2,754.23
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,778.28 / $2,511.89
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,862.09 / $2,818.38
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $977.24 / $1,348.96
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,348.96
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $977.24 / $1,348.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,778.28 / $2,570.40
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $2,511.89 / $2,511.89
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,344.23 / $4,365.16
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $1,698.24 / $2,511.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $977.24 / $1,412.54