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Idaho 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
$836.54 / $1,858.97 / $1,858.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,331.58 / $1,540.39 / $1,540.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.48 / $1,124.48 / $1,586.60
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.83 / $1,495.45 / $2,123.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,910.70 / $2,016.85 / $2,123.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,586.03 / $1,910.70
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.97 / $2,073.23 / $3,109.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,486.10 / $1,539.30 / $2,229.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$896.29 / $969.40 / $1,493.81