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Colorado 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
$1,231.44 / $1,408.80 / $1,408.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$725.00 / $1,231.44 / $1,646.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,199.00 / $2,470.80 / $4,485.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.67 / $1,181.67 / $1,276.20
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 / $2,316.04
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.83 / $1,199.40 / $2,922.01
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.83 / $625.83 / $625.83
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,605.27 / $2,748.75 / $4,354.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.20 / $969.40 / $1,460.26