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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
$1,082.40 / $1,082.40 / $1,082.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.89 / $1,082.40 / $1,914.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,186.92 / $2,186.92 / $2,631.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,540.39 / $1,540.39 / $1,700.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.48 / $1,315.12 / $1,540.39
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$973.17 / $1,600.27 / $3,434.54
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,600.27 / $1,600.27 / $1,600.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,477.77 / $1,477.77 / $1,477.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$727.35 / $1,042.39 / $1,461.24