go back

Michigan 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
$132.38 / $499.45 / $499.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.86 / $499.45 / $599.33
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.92 / $655.92 / $874.56
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,323.70 / $2,637.32 / $4,803.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$830.83 / $874.56 / $1,180.66
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$527.11 / $568.46 / $590.67
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.65 / $699.65 / $699.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.00 / $510.00 / $516.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.00 / $510.00 / $1,014.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.38 / $508.44 / $632.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.62 / $632.00 / $1,005.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.67 / $647.16 / $744.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.49 / $404.56 / $618.54