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Massachusetts 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
$927.59 / $927.59 / $927.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.59 / $1,004.13 / $1,359.71
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,899.46 / $6,047.64 / $10,128.96
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.20 / $1,577.08 / $2,073.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,318.06 / $2,741.44 / $3,530.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,390.16 / $1,636.65 / $1,636.65
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 / $2,521.50
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,718.89 / $1,718.89 / $1,804.83
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,616.49 / $1,616.49 / $1,616.49
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,415.51 / $10,128.96 / $10,128.96
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$807.83 / $1,059.14 / $2,073.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$829.30 / $1,059.14 / $2,073.23