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Mississippi 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
$1,225.56 / $1,225.56 / $1,953.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.44 / $1,397.91 / $1,953.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,694.69 / $1,694.69 / $1,694.69
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,694.69 / $1,694.69 / $1,694.69
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 / $1,540.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.26 / $1,038.22 / $1,628.59