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Montana 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 $2,138 · 10th–90th $1,445–$2,6920%20%10th90th$2,138Professionalmedian $1,259 · 10th–90th $724–$2,6920%10%10th90th$1,259$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,230.27 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $2,290.87 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $2,290.87 / $2,290.87
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,137.96 / $4,168.69
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,137.96 / $4,168.69
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $2,041.74 / $2,630.27
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,737.80 / $2,290.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $1,202.26 / $1,258.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $977.24 / $1,479.11