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Illinois 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
$1,122.02 / $1,122.02 / $2,238.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,122.02 / $1,949.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $4,265.80 / $15,135.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,659.59 / $1,659.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $2,454.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $2,398.83
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,862.09 / $2,398.83 / $2,951.21
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,818.38 / $2,818.38 / $2,818.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,737.80 / $3,162.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,096.48 / $1,659.59