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Maryland 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
$868.90 / $927.59 / $1,659.60
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,356.13 / $1,356.13 / $1,451.27
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 / $1,124.48 / $1,540.39
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,486.10 / $2,123.00 / $3,057.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$821.60 / $1,059.14 / $1,688.25
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,164.16 / $1,164.16 / $1,486.10