go back

Vermont 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
$877.47 / $877.47 / $1,012.47
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
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.38 / $1,028.38 / $1,028.38
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$750.72 / $750.72 / $750.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.04 / $1,065.16 / $2,078.73