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Wisconsin 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 $2,239 · 10th–90th $1,995$4,0740%50%10th90th$2,239Professionalmedian $1,445 · 10th–90th $977$3,3110%20%10th90th$1,445$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
$1,096.48 / $1,096.48 / $1,096.48
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,096.48 / $1,584.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,238.72 / $3,630.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,041.74 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $5,128.61 / $10,964.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $3,162.28 / $4,168.69
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,778.28 / $2,754.23
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $2,137.96 / $2,630.27
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $2,187.76 / $10,232.93
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,148.15 / $2,398.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $1,202.26
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $3,467.37 / $3,467.37
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $2,511.89 / $4,365.16
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $3,311.31 / $6,165.95
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $4,365.16 / $10,232.93
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $2,238.72 / $10,964.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$660.69 / $1,122.02 / $2,238.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $1,096.48 / $1,862.09