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Illinois 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
$446.68 / $446.68 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $478.63 / $891.25
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $870.96 / $1,258.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,698.24 / $6,025.60
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $660.69 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $588.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $977.24
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $977.24 / $1,202.26
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,148.15 / $1,148.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $457.09 / $660.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $691.83 / $1,318.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $436.52 / $691.83