go back

California 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
$486.62 / $486.62 / $3,116.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.86 / $486.62 / $1,233.85
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.74 / $734.58 / $799.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$369.53 / $1,522.32 / $3,429.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.64 / $492.70 / $813.34
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.00 / $1,278.94 / $2,283.82
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $1,433.34 / $3,338.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$504.92 / $510.00 / $577.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.30 / $372.30 / $543.69
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.52 / $471.02 / $1,188.30
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$648.16 / $756.19 / $1,642.01
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,566.39 / $4,248.13 / $5,131.28
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,185.30 / $5,282.69 / $6,232.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,025.11 / $2,025.11 / $2,025.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.95 / $918.23 / $1,080.27
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.30 / $510.00 / $867.13
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,038.98 / $2,038.98 / $2,038.98
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$392.52 / $667.28 / $864.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$373.72 / $404.86 / $962.63