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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$880.51 / $1,107.78 / $1,195.22
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,849.25 / $3,848.28 / $4,555.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,059.06 / $1,059.06 / $1,771.20
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 / $1,335.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$787.20 / $1,005.38 / $1,675.63