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Montana 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 $1,820 · 10th–90th $1,202–$2,2910%20%40%10th90th$1,820Professionalmedian $1,072 · 10th–90th $617–$2,2910%10%10th90th$1,072$100.0$200.0$500.0$1.0K$2.0K$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
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $1,047.13 / $1,584.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,949.84 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,949.84 / $1,949.84
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,819.70 / $3,548.13
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $1,819.70 / $3,548.13
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $1,737.80 / $2,238.72
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $1,479.11 / $1,949.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $1,023.29 / $1,071.52
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $812.83 / $1,258.93