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Virginia 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 $2,188 · 10th–90th $1,023–$2,6920%20%40%10th90th$2,188Professionalmedian $1,175 · 10th–90th $871–$1,9950%50%10th90th$1,175$2.0$10.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $1,047.13 / $2,691.53
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,047.13 / $1,905.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,187.76 / $2,290.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,174.90 / $2,454.71
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,479.11
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $1,548.82 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,122.02 / $1,122.02
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,187.76 / $3,019.95
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,445.44 / $1,445.44
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $1,412.54 / $2,511.89
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,318.26 / $2,691.53
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,819.70 / $4,677.35
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,819.70 / $4,677.35
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $954.99 / $2,630.27
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,047.13 / $1,737.80