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Utah 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

Facilitymedian $1,259 · 10th–90th $631–$2,1880%20%40%10th90th$1,259Professionalmedian $1,514 · 10th–90th $631–$9,3330%10%10th90th$1,514$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $630.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $1,230.27 / $9,332.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,548.82
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $1,621.81 / $2,041.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,187.76 / $2,187.76
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,584.89 / $2,398.83
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,187.76 / $2,238.72
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $2,238.72 / $2,570.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $954.99 / $1,258.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $977.24 / $1,621.81