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Montana 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
$708.53 / $5,188.07 / $5,188.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.38 / $1,955.64 / $1,955.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.38 / $1,955.64 / $1,955.64
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$917.56 / $1,862.51 / $1,955.64
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,448.47 / $1,500.32 / $1,957.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.09 / $821.06 / $1,256.45