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Ohio 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

Facilitymedian $1,905 · 10th–90th $1,000$3,1620%20%10th90th$1,905Professionalmedian $977 · 10th–90th $759$1,6600%20%10th90th$977$2.0$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,445.44 / $1,737.80
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $933.25 / $1,258.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $1,995.26 / $3,981.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,096.48 / $2,454.71
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,584.89 / $2,238.72
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,659.59 / $2,511.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,023.29
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,023.29
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,023.29
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,584.89 / $2,290.87
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,238.72 / $2,238.72
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,089.30 / $3,890.45
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $1,513.56 / $2,238.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $870.96 / $1,258.93