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Texas 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
$976.55 / $995.70 / $1,014.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$919.11 / $1,014.85 / $1,646.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,302.07 / $1,302.07 / $1,302.07
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,186.77 / $2,186.77 / $2,186.77
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,654.22 / $10,128.96 / $10,128.96
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,951.02 / $10,951.02 / $15,922.50
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.83 / $1,641.72 / $2,186.77
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.83 / $1,968.09 / $2,186.77
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,672.88 / $2,186.77 / $4,920.22
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.83 / $1,540.39 / $2,186.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.48 / $1,124.48 / $1,586.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$807.83 / $1,168.21 / $1,390.73
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,164.16 / $1,181.67 / $2,186.77