go back

New Jersey 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
$612.14 / $612.14 / $612.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.14 / $782.51 / $989.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.38 / $1,028.38 / $1,798.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.72 / $750.72 / $2,135.63
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,642.73 / $1,654.28 / $2,355.55
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.99 / $1,798.13 / $1,798.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$745.52 / $897.07 / $1,650.78