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Michigan 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 $2,239 · 10th–90th $1,047–$7,4130%20%10th90th$2,239Professionalmedian $1,000 · 10th–90th $776–$1,8620%20%10th90th$1,000$2.0$10.0$50.0$200.0$1.0K$5.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,047.13 / $1,047.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $977.24 / $1,288.25
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,454.71 / $5,495.41 / $10,715.19
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,862.09 / $1,949.84
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,202.26 / $1,202.26
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 / $1,230.27 / $2,041.74
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $3,467.37 / $3,890.45
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,479.11 / $2,238.72
Priority Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,202.26 / $1,202.26
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,230.27 / $1,862.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $1,513.56 / $2,238.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $870.96 / $1,288.25