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South Carolina 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
$1,071.52 / $1,071.52 / $1,071.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,122.02 / $1,905.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $2,344.23 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $3,467.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $2,511.89
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,445.44
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,584.89 / $3,467.37
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $616.60 / $630.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $1,479.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.55 / $1,202.26 / $2,630.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,071.52 / $1,380.38