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Louisiana 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
$1,181.85 / $1,254.58 / $1,690.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,038.55 / $1,254.58 / $1,363.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,903.34 / $3,251.58 / $4,570.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,298.02 / $1,552.61 / $1,552.61
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $1,540.39 / $1,540.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.26 / $1,008.67 / $1,537.45