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Indiana 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
$1,076.57 / $1,076.57 / $2,175.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,035.16 / $1,080.54 / $1,168.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,718.35 / $1,946.74 / $2,175.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,061.08 / $1,181.67 / $1,595.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,640.19 / $2,392.64 / $3,262.70
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,848.86 / $2,392.64 / $2,936.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,540.39 / $1,540.39 / $2,175.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.48 / $1,540.39 / $2,231.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.26 / $1,036.77 / $1,460.58