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Maine 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
$831.76 / $1,047.13 / $2,754.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,137.96 / $2,454.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,000.00 / $1,318.26
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 / $1,023.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,584.89 / $1,905.46
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,096.48 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,023.29 / $1,737.80