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Minnesota 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 $2,138 · 10th–90th $1,585–$13,4900%20%10th90th$2,138Professionalmedian $1,862 · 10th–90th $912–$2,1380%50%10th90th$1,862$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
$1,288.25 / $1,288.25 / $1,288.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,071.52 / $1,288.25
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,862.09 / $2,398.83
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $1,862.09 / $1,862.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,265.80 / $6,918.31 / $16,595.87
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,454.71 / $2,691.53
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,495.41 / $6,918.31 / $13,489.63
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,137.96 / $2,884.03
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $1,862.09 / $8,511.38
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $812.83 / $1,995.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $812.83 / $2,691.53
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $954.99 / $2,570.40