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Arkansas rates for HCPCS L3960

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning, airplane design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.07 / $549.07 / $549.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.66 / $549.07 / $549.07
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.29 / $790.29 / $790.29
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$852.80 / $1,128.71 / $1,254.11
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.94 / $810.94 / $908.74
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$810.94 / $810.94 / $810.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.00 / $510.00 / $790.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.30 / $510.00 / $771.77
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$908.83 / $908.83 / $908.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.47 / $437.89 / $593.90