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Ohio 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
$424.84 / $424.84 / $1,467.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.94 / $424.84 / $504.34
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$742.73 / $870.08 / $2,254.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.87 / $463.19 / $1,028.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$593.24 / $804.27 / $1,107.36
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$553.69 / $790.98 / $1,693.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.25 / $494.25 / $1,108.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $360.80 / $631.40
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.25 / $494.25 / $494.25
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $494.25 / $494.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$263.08 / $394.61 / $573.24