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Connecticut 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
$1,031.83 / $1,031.83 / $1,031.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$923.88 / $1,014.85 / $1,038.55
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,645.33 / $2,123.00 / $2,428.92
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.67 / $1,181.67 / $1,240.02
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 / $1,540.39
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,379.95 / $1,379.95 / $1,379.95
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,379.95 / $1,379.95 / $1,953.16
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,616.49 / $1,616.49 / $1,616.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.28 / $1,059.14 / $1,765.23