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Mississippi 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
$1,038.03 / $1,038.03 / $1,654.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.46 / $1,184.00 / $1,654.36
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,435.38 / $1,435.38 / $1,435.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,435.38 / $1,435.38 / $1,435.38
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.38 / $879.35 / $1,379.39