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Arizona rates for HCPCS L3962

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning, Erb's palsy design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$421.86 / $442.95 / $828.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$276.88 / $1,000.23 / $1,808.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.20 / $922.94 / $1,257.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.25 / $494.25 / $494.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $360.80 / $916.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.75 / $704.68 / $4,154.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.30 / $394.61 / $594.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$356.66 / $394.61 / $594.42