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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
$607.66 / $607.66 / $607.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$417.25 / $486.62 / $607.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$753.75 / $933.48 / $1,229.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$699.65 / $830.83 / $874.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.00 / $2,698.11 / $7,493.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,014.00 / $1,074.83 / $1,287.78
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,601.83 / $2,588.69 / $5,900.60
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,014.00 / $1,014.00 / $1,043.20
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.77 / $874.56 / $4,248.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.47 / $418.10 / $973.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.47 / $404.20 / $943.54