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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

Facilitymedian $2,512 · 10th–90th $1,549–$2,8840%20%40%10th90th$2,512Professionalmedian $1,230 · 10th–90th $933–$1,8620%20%10th90th$1,230$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,202.26 / $3,235.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,511.89 / $2,884.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,174.90 / $1,548.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,548.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $1,862.09 / $2,238.72
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,230.27 / $1,348.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $954.99 / $954.99
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,819.70 / $1,862.09