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Alaska 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
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,258.93 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,584.89
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $1,819.70 / $2,041.74
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,187.76 / $6,918.31
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $2,089.30 / $2,187.76
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,089.30 / $2,137.96
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $630.96 / $2,187.76
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,548.82 / $2,041.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,258.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,698.24 / $5,248.07