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Rhode Island 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
Professional
Modifier
Low / Median / High Price
$927.59 / $1,167.04 / $1,259.14
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,001.60 / $4,054.08 / $4,799.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$948.34 / $1,115.69 / $1,865.92
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 / $1,540.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$821.60 / $1,059.14 / $1,765.23