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Massachusetts 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
$785.65 / $785.65 / $785.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$785.65 / $865.98 / $1,151.65
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,403.42 / $4,577.96 / $8,579.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.52 / $1,335.77 / $1,755.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,963.36 / $2,321.94 / $2,990.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,177.44 / $1,386.22 / $1,386.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.38 / $1,028.38 / $1,028.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.72 / $750.72 / $2,135.63
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,455.87 / $1,455.87 / $1,528.66
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,119.83 / $1,119.83 / $1,119.83
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,739.91 / $8,579.00 / $8,579.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.22 / $897.07 / $1,755.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$702.40 / $961.18 / $1,755.99