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Rhode Island 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
$785.65 / $988.46 / $1,066.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,542.31 / $3,433.72 / $4,065.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$944.97 / $944.97 / $1,580.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.38 / $1,028.38 / $1,028.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.72 / $750.72 / $750.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.88 / $897.07 / $1,495.12