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Mississippi 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
$1,047.13 / $1,047.13 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,000.00 / $1,659.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
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
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $1,479.11 / $2,238.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $870.96 / $1,258.93