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New York 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
$722.74 / $923.88 / $1,710.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$722.74 / $927.59 / $1,338.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,123.00 / $2,165.46 / $4,246.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,181.67 / $1,181.67 / $3,290.32
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,644.95 / $1,768.76 / $1,768.76
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,768.76 / $1,768.76 / $1,768.76
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 / $1,124.48 / $1,540.39
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $2,123.00 / $4,776.75
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,227.74 / $1,571.02 / $3,821.40
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,534.67 / $1,534.67 / $1,534.67
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,276.35 / $1,356.14 / $1,768.76
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $1,540.39 / $2,123.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.48 / $1,312.11 / $3,151.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$706.09 / $1,102.21 / $1,943.11
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,134.82 / $1,276.35 / $1,276.35
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,276.35 / $1,276.35 / $1,534.67