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Arizona 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
$849.20 / $1,082.40 / $1,914.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.37 / $2,013.49 / $3,640.31
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,393.41 / $1,857.88 / $2,531.36
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 / $1,124.48 / $2,521.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.83 / $1,214.35 / $10,128.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$875.28 / $969.40 / $1,460.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.16 / $969.40 / $1,418.53