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Maine 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
$927.59 / $1,288.61 / $1,288.61
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,888.20 / $2,446.33 / $4,534.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.67 / $1,240.02 / $1,240.02
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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,718.89 / $1,718.89 / $1,718.89
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,195.39 / $1,288.61 / $1,288.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.91 / $1,059.14 / $2,435.67