go back

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.83 / $625.83 / $625.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.83 / $725.00 / $6,125.35
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 / $1,586.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$995.30 / $1,605.33 / $2,086.92
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,925.52 / $2,147.46 / $2,147.46
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,222.83 / $1,539.30 / $2,308.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.03 / $969.40 / $1,138.54