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Massachusetts 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
$420.60 / $420.60 / $420.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$282.92 / $420.60 / $566.76
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$544.60 / $1,718.35 / $5,131.28
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$376.02 / $641.05 / $940.05
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$556.80 / $556.80 / $1,653.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.34 / $650.97 / $650.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.00 / $556.80 / $674.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.30 / $510.00 / $899.73
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.39 / $779.39 / $818.36
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$577.35 / $577.35 / $577.35
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,775.36 / $5,131.28 / $5,131.28
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$336.84 / $480.24 / $940.05
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.57 / $480.24 / $831.05