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Iowa 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
$589.46 / $607.66 / $607.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.74 / $486.62 / $811.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.00 / $510.00 / $976.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.00 / $1,014.00 / $1,267.50
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$792.18 / $897.30 / $972.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.85 / $1,076.61 / $4,248.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$404.20 / $467.15 / $1,213.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$973.96 / $976.82 / $1,230.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.02 / $1,141.06 / $1,866.66
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$888.02 / $951.07 / $1,592.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.60 / $443.02 / $1,044.83
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$843.62 / $843.62 / $843.62
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.46 / $843.62 / $843.62