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Massachusetts 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
Facility
Modifier
Low / Median / High Price
$460.81 / $460.81 / $460.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$424.84 / $460.81 / $593.84
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$694.10 / $1,605.69 / $5,009.54
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$386.38 / $694.10 / $1,029.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$610.03 / $610.03 / $1,811.79
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$690.59 / $713.20 / $713.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.25 / $610.03 / $739.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $494.25 / $916.88
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.90 / $853.90 / $896.60
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.16 / $601.16 / $601.16
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,605.69 / $5,009.54 / $5,009.54
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.77 / $526.15 / $1,029.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.77 / $526.15 / $853.90