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Vermont 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
$380.19 / $489.78 / $588.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $776.25 / $776.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $512.86 / $707.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $549.54
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $812.83 / $1,071.52
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $501.19 / $562.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $616.60 / $1,995.26