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Vermont 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
$983.41 / $983.41 / $1,134.71
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 / $975.01 / $1,375.70
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,335.63 / $1,335.63 / $1,335.63
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$975.01 / $1,335.63 / $1,375.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$670.25 / $1,193.75 / $2,329.69