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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,511.33 / $1,511.33 / $1,511.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,004.13 / $1,511.33 / $1,599.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,874.67 / $2,321.67 / $3,058.32
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,740.10 / $2,066.37 / $2,175.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,540.39 / $6,711.13 / $18,639.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,521.50 / $2,672.79 / $3,202.31
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,984.32 / $6,439.00 / $14,676.84
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,521.50 / $2,521.50 / $2,594.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.60 / $2,175.13 / $10,128.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.26 / $1,076.22 / $2,373.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.26 / $1,059.14 / $2,827.67