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Wisconsin rates for HCPCS L3960

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning, airplane design, prefabricated, includes fitting and adjustment

Facilitymedian $891 · 10th–90th $724$1,6220%50%10th90th$891Professionalmedian $692 · 10th–90th $417$1,4790%20%10th90th$692$1.0$5.0$20.0$100.0$500.0$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $436.52 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $467.74 / $912.01
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $1,479.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $831.76 / $1,000.00
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $2,041.74 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $1,258.93 / $1,698.24
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $724.44 / $1,096.48
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,000.00 / $1,202.26
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $870.96 / $4,265.80
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $478.63 / $1,000.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $398.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,412.54 / $1,412.54
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $1,000.00 / $1,737.80
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,348.96 / $2,570.40
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $1,778.28 / $5,128.61
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $741.31 / $5,248.07
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $467.74 / $891.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $794.33 / $1,819.70