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North Dakota 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
$1,355.06 / $1,355.06 / $1,355.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,280.08 / $1,280.08 / $1,355.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,741.45 / $2,059.00 / $2,110.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,135.63 / $2,156.98 / $2,712.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$545.96 / $1,355.06 / $8,579.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.00 / $911.54 / $1,484.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$465.27 / $765.93 / $1,484.00