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Idaho 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
$415.57 / $862.05 / $862.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.25 / $494.25 / $661.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $494.25 / $526.90
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.75 / $693.48 / $984.48
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$886.03 / $935.26 / $984.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $735.48 / $886.03
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$862.05 / $961.41 / $1,442.12
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$689.14 / $689.14 / $1,033.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.85 / $394.61 / $657.81