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Texas 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 $1,514 · 10th–90th $813$5,2480%10%20%10th90th$1,514Professionalmedian $891 · 10th–90th $759$1,2020%50%10th90th$891$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
$831.76 / $831.76 / $851.14
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $870.96 / $1,202.26
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $891.25 / $891.25
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $1,905.46 / $1,905.46
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,023.29
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,709.64 / $8,709.64 / $8,709.64
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9,549.93 / $13,489.63 / $13,489.63
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $1,621.81 / $2,630.27
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $912.01 / $1,819.70
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $933.25 / $933.25
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $1,445.44 / $2,570.40
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $1,023.29
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $1,174.90 / $1,905.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $1,000.00 / $1,174.90
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,905.46 / $1,905.46