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Nebraska 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
$566.29 / $566.29 / $566.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$486.62 / $566.29 / $705.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$780.49 / $858.53 / $867.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$510.00 / $976.82 / $976.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.00 / $976.82 / $1,506.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$444.90 / $972.01 / $4,248.13
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.43 / $443.02 / $695.02
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$973.96 / $976.82 / $1,230.81
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$884.44 / $1,154.43 / $2,012.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$321.19 / $443.02 / $608.27