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Maine 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

Facilitymedian $2,089 · 10th–90th $1,202–$2,4550%20%10th90th$2,089Professionalmedian $1,047 · 10th–90th $776–$1,5850%20%10th90th$1,047$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,023.29 / $2,754.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,137.96 / $2,454.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,318.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $870.96 / $1,202.26
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,584.89 / $1,905.46
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,047.13 / $1,122.02
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$524.81 / $812.83 / $812.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,548.82 / $1,584.89