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Vermont 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
Professional
Modifier
Low / Median / High Price
$912.01 / $1,174.90 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,548.82 / $1,548.82 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,548.82
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,089.30 / $2,570.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $954.99 / $1,202.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,479.11 / $4,466.84