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Montana 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
$486.62 / $486.62 / $535.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$791.22 / $791.22 / $791.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.00 / $850.71 / $850.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.00 / $691.81 / $850.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.70 / $810.20 / $850.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.00 / $638.50 / $867.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.32 / $404.20 / $618.54