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South Carolina 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
$1,027.43 / $1,027.43 / $1,027.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$985.81 / $1,027.43 / $1,817.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,100.00 / $1,386.81 / $2,200.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $1,335.63 / $1,474.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $1,248.33 / $1,335.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$923.75 / $1,519.00 / $3,260.12
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,519.00 / $1,519.00 / $1,519.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,402.72 / $1,402.72 / $1,402.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.42 / $989.45 / $1,248.33