go back

Maine rates for HCPCS L3978

Shoulder-elbow-wrist-hand-finger orthosis (SEWHO), abduction positioning (airplane design), thoracic component and support bar, 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
$1,014.85 / $1,288.61 / $1,288.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,888.20 / $2,446.33 / $4,534.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,183.49 / $1,240.02 / $1,240.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,407.05 / $1,407.05 / $1,407.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,027.15 / $1,027.15 / $1,407.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,718.89 / $1,718.89 / $1,718.89
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.39 / $1,288.61 / $1,288.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$706.09 / $1,059.14 / $2,435.67