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Missouri 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
$1,133.08 / $1,133.08 / $1,509.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,117.97 / $1,174.29 / $1,792.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,164.44 / $2,272.67 / $9,991.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,075.80 / $1,181.67 / $1,780.35
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 / $1,586.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,082.40 / $1,761.44 / $10,128.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$803.14 / $1,079.82 / $2,630.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.91 / $1,079.82 / $1,643.36