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Nebraska 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
$1,380.31 / $1,380.31 / $1,380.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.31 / $1,380.31 / $1,792.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.34 / $2,092.57 / $2,113.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,540.39 / $2,380.90 / $2,380.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,540.39 / $2,380.90 / $3,671.39
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,089.74 / $2,369.17 / $10,128.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$746.91 / $1,079.82 / $1,694.06
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,373.94 / $2,380.90 / $2,999.83
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,125.00 / $2,813.79 / $4,905.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.86 / $1,079.82 / $1,493.81