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Connecticut 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
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $912.01 / $1,659.59
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,819.70 / $2,187.76
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,047.13 / $1,047.13
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 / $758.58
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.90 / $1,174.90 / $1,174.90
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,288.25 / $1,778.28
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,122.02 / $1,122.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $676.08 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $891.25 / $1,258.93