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North Carolina 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
$1,914.94 / $1,914.94 / $3,303.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.67 / $1,914.94 / $1,914.94
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,992.26 / $3,243.97 / $3,995.04
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,522.53 / $1,640.19 / $1,640.19
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 / $1,540.39 / $2,521.50
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.83 / $1,914.94 / $2,626.94
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,600.27 / $1,600.27 / $1,600.27
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,547.60 / $2,547.60 / $3,917.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$802.34 / $1,076.22 / $1,540.48
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,417.06 / $10,128.96 / $10,128.96
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,951.02 / $15,922.50 / $15,922.50