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Maryland rates for HCPCS L3960

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning, airplane design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.90 / $431.55 / $630.60
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$435.00 / $435.00 / $554.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.00 / $510.00 / $516.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.30 / $372.30 / $510.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$567.66 / $810.94 / $1,167.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$342.57 / $404.56 / $644.87
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$395.42 / $485.40 / $567.66