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Michigan 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
$451.72 / $451.72 / $451.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.64 / $451.72 / $512.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,197.20 / $2,385.28 / $4,344.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$751.43 / $790.98 / $1,067.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$514.14 / $514.14 / $615.03
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$632.78 / $632.78 / $632.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.25 / $494.25 / $494.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.25 / $494.25 / $916.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.72 / $571.60 / $571.60
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.72 / $571.60 / $862.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,117.92 / $1,363.32 / $1,567.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.98 / $378.14 / $566.12