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North Carolina 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
$1,621.92 / $1,621.92 / $2,797.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.80 / $1,621.92 / $1,621.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,485.10 / $1,782.12 / $3,383.73
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,289.56 / $1,389.21 / $1,389.21
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 / $1,191.78 / $2,135.63
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.05 / $1,621.92 / $2,224.98
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,355.41 / $1,355.41 / $1,355.41
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,157.80 / $2,157.80 / $3,317.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$679.57 / $915.84 / $1,304.76
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,894.19 / $8,579.00 / $8,579.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,275.29 / $13,485.98 / $13,485.98