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Michigan 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
$1,242.19 / $1,242.19 / $1,242.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.83 / $1,242.19 / $1,242.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,292.19 / $6,559.32 / $11,946.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,066.37 / $2,175.13 / $2,936.43
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,379.95 / $1,413.83 / $1,421.50
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,740.10 / $1,740.10 / $1,740.10
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
$1,453.35 / $1,540.39 / $2,521.50
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,242.19 / $1,571.84 / $1,571.84
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,242.19 / $1,571.84 / $2,446.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.03 / $1,021.45 / $1,537.45