go back

Minnesota 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
$602.56 / $602.56 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $562.34 / $1,258.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $870.96 / $1,288.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,862.09 / $3,235.94 / $7,762.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,148.15 / $1,288.25
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $3,235.94 / $6,165.95
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,380.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $870.96 / $1,778.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $407.38 / $977.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6.46 / $398.11 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $436.52 / $1,071.52