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Washington, DC 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
$735.94 / $735.94 / $735.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.94 / $735.94 / $735.94
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.60 / $1,148.60 / $1,229.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $870.00 / $870.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,168.78 / $1,168.78 / $3,569.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.04 / $897.07 / $1,347.85