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Connecticut rates for HCPCS L3975

Shoulder-elbow-wrist-hand-finger orthosis (SEWHO), shoulder cap design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$873.95 / $873.95 / $873.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$782.51 / $859.54 / $879.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,393.55 / $1,798.13 / $2,057.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,002.36 / $1,002.36 / $1,050.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.78 / $1,191.78 / $1,191.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $870.00 / $1,191.78
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,168.78 / $1,168.78 / $1,168.78
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,168.78 / $1,168.78 / $1,654.28
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,368.20 / $1,368.20 / $1,368.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$688.17 / $897.07 / $1,495.12