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Maine 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
$460.81 / $640.15 / $640.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$938.00 / $1,215.26 / $2,252.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.00 / $504.76 / $504.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.25 / $494.25 / $775.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $360.80 / $494.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$853.90 / $853.90 / $853.90
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.84 / $640.15 / $640.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.77 / $526.15 / $1,209.98