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South Carolina 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
$446.68 / $446.68 / $446.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $467.74 / $812.83
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $741.31 / $1,258.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $912.01 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$407.38 / $512.86 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $1,023.29
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $489.78 / $537.03
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $707.95 / $1,445.44
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $257.04 / $263.03
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $616.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $501.19 / $1,096.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.84 / $446.68 / $575.44