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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
$870.96 / $1,148.15 / $2,137.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,122.02 / $1,905.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,202.26 / $4,365.16
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,174.90 / $2,570.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $8,912.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $3,162.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,230.27 / $2,630.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,047.13 / $1,698.24