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Washington 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 $2,138 · 10th–90th $1,445$5,1290%20%10th90th$2,138Professionalmedian $1,445 · 10th–90th $933$3,0900%10%20%10th90th$1,445$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$1,445.44 / $1,445.44 / $3,388.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,174.90 / $1,905.46
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,089.30 / $2,089.30
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $1,819.70 / $2,398.83
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
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $2,884.03 / $6,025.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $2,511.89 / $4,466.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $1,621.81 / $1,778.28
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,089.30 / $2,137.96
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,137.96 / $2,754.23
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $3,090.30 / $4,265.80
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,778.28 / $2,089.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,089.30 / $2,089.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $1,819.70 / $2,398.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $3,162.28 / $3,162.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,047.13 / $1,862.09
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,513.56 / $3,235.94