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Hawaii 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
$612.14 / $612.14 / $612.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,428.46 / $1,428.46 / $1,428.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.38 / $1,977.94 / $1,977.94
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,798.13 / $1,882.86 / $1,882.86
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,078.88 / $1,798.13 / $2,517.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,253.13 / $1,428.46 / $1,977.94
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,448.47 / $1,498.11 / $1,711.49