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Wisconsin 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 $1,862 · 10th–90th $1,738$3,3880%20%40%10th90th$1,862Professionalmedian $1,202 · 10th–90th $832$2,8180%20%10th90th$1,202$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
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$933.25
Typical High
$933.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$933.25
Typical High
$1,348.96
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,862.09
Median
$1,862.09
Typical High
$3,090.30
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$1,737.80
Typical High
$2,089.30
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$4,365.16
Typical High
$9,332.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$2,691.53
Typical High
$3,548.13
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$1,513.56
Typical High
$2,344.23
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,778.28
Typical High
$2,238.72
Medica
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$1,862.09
Typical High
$8,511.38
Medica
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$954.99
Typical High
$2,041.74
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$70.79
Typical High
$1,202.26
Network Health
Setting
Facility
Modifier
Global
Typical Low
$2,951.21
Median
$2,951.21
Typical High
$2,951.21
Network Health
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$2,137.96
Typical High
$3,715.35
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$2,818.38
Typical High
$5,128.61
Quartz
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$3,715.35
Typical High
$8,511.38
Quartz
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$1,513.56
Typical High
$9,332.54
United
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$954.99
Typical High
$1,862.09
United
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$912.01
Typical High
$1,548.82