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Georgia 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
$879.64 / $879.64 / $2,089.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$833.34 / $988.46 / $1,394.72
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,852.28 / $2,593.19 / $6,797.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.82 / $1,540.14 / $2,957.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,528.41 / $1,574.44 / $3,426.72
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,574.44 / $1,574.44 / $1,574.44
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 / $2,135.63
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,407.73 / $1,852.28 / $2,575.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.05 / $924.08 / $1,524.58