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Maryland 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
Professional
Modifier
Low / Median / High Price
$735.94 / $785.65 / $1,405.65
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.60 / $1,148.60 / $1,229.19
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.69 / $1,798.13 / $2,589.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.09 / $897.07 / $1,429.92
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$985.99 / $985.99 / $1,258.69