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Maine 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
$458.45 / $584.29 / $584.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$856.15 / $1,109.22 / $2,056.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$492.70 / $517.03 / $517.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.00 / $510.00 / $707.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.30 / $372.30 / $510.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.39 / $779.39 / $779.39
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.62 / $542.03 / $584.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.16 / $480.80 / $1,104.41