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Nationwide rates for HCPCS L3967

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning (airplane design), thoracic component and support bar, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,097.27 / $1,117.97 / $1,408.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.59 / $1,167.04 / $1,626.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,123.00 / $2,272.67 / $4,246.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.67 / $1,181.67 / $1,716.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,540.39 / $1,540.39 / $1,540.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.48 / $1,315.12 / $1,586.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.86 / $1,059.14 / $1,595.45