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Nebraska 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
$588.78 / $588.78 / $588.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.78 / $588.78 / $764.53
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$811.46 / $892.60 / $901.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.25 / $1,015.59 / $1,015.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$494.25 / $1,015.59 / $1,566.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.55 / $1,010.59 / $4,154.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.07 / $460.60 / $767.67
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,012.62 / $1,015.59 / $1,279.58
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,200.24 / $2,092.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$326.94 / $460.60 / $593.83