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Alaska rates for HCPCS L3961

Shoulder-elbow-wrist-hand orthosis (SEWHO), shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,071.52 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $758.58 / $1,047.13
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $1,737.80 / $1,737.80
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,819.70 / $5,888.44
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $1,819.70
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,737.80 / $1,778.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $1,819.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $1,023.29 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $812.83 / $1,071.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,412.54 / $4,466.84