go back

Utah 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
$257.04 / $257.04 / $257.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $489.78 / $870.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $549.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $588.84 / $776.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $707.95 / $1,230.27
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $575.44 / $870.96
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $812.83 / $933.25
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $831.76 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $407.38 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $407.38 / $575.44