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Indiana 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
$436.52 / $436.52 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $467.74 / $794.33
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $741.31 / $1,258.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $891.25 / $1,122.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $489.78 / $891.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $1,148.15 / $1,348.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $891.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$309.03 / $562.34 / $691.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $426.58 / $616.60