go back

Minnesota 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 $2,570 · 10th–90th $1,862–$15,8490%20%10th90th$2,570Professionalmedian $2,188 · 10th–90th $1,096–$2,5120%20%40%10th90th$2,188$2.0$10.0$50.0$200.0$1.0K$5.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,513.56 / $1,513.56
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,258.93 / $1,513.56
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,187.76 / $2,818.38
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,187.76 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,128.31 / $19,498.45
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $2,884.03 / $3,235.94
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,456.54 / $8,128.31 / $15,848.93
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,511.89 / $2,511.89 / $3,467.37
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $2,187.76 / $10,232.93
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $977.24 / $2,398.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.49 / $954.99 / $3,162.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,148.15 / $3,090.30