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Utah 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 $1,202 · 10th–90th $589–$2,0890%20%40%10th90th$1,202Professionalmedian $1,445 · 10th–90th $589–$8,7100%10%10th90th$1,445$50.0$100.0$200.0$500.0$1.0K$2.0K$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $588.84 / $588.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$588.84 / $1,174.90 / $8,709.64
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,348.96
Cigna
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
$60.26 / $1,513.56 / $1,949.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,089.30 / $2,089.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,479.11 / $2,238.72
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,089.30 / $2,137.96
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $2,137.96 / $2,454.71
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $912.01 / $1,202.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $912.01 / $1,548.82