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New Hampshire 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 $2,188 · 10th–90th $1,202–$2,5700%10%20%10th90th$2,188Professionalmedian $1,445 · 10th–90th $933–$1,9950%20%10th90th$1,445$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
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,202.26 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,202.26 / $1,862.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,290.87 / $2,630.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,174.90 / $1,174.90
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,548.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $1,862.09 / $3,467.37
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $954.99 / $1,258.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $1,258.93 / $1,862.09
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,041.74 / $3,019.95