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North Dakota 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
$1,599.87 / $1,599.87 / $1,599.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,511.33 / $1,511.33 / $1,599.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,056.07 / $2,430.98 / $2,491.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,521.50 / $2,546.71 / $3,202.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$644.60 / $1,599.87 / $10,128.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.05 / $1,076.22 / $1,752.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$646.26 / $1,076.22 / $2,306.17