go back

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
$870.96 / $1,096.48 / $3,090.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $3,981.07 / $4,677.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,047.13 / $2,137.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $1,122.02 / $2,511.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,071.52 / $1,659.59