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Iowa 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
$1,511.33 / $1,511.33 / $1,599.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$873.72 / $1,167.04 / $1,953.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,540.39 / $1,540.39 / $2,380.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,540.39 / $2,521.50 / $3,151.88
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,066.37 / $2,218.08 / $2,396.57
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,359.71 / $2,569.26 / $10,128.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.75 / $1,115.81 / $2,957.27
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,373.94 / $2,380.90 / $2,951.88
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.98 / $2,781.22 / $4,549.85
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,175.13 / $2,329.56 / $3,940.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.75 / $1,079.82 / $2,546.71
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,056.23 / $2,056.23 / $2,056.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,624.42 / $2,056.23 / $2,056.23