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New Jersey 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
$612.14 / $612.14 / $612.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.14 / $782.51 / $989.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.78 / $1,191.78 / $1,798.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $870.00 / $1,574.51
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,642.73 / $1,654.28 / $2,355.55
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,755.99 / $1,798.13 / $1,798.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$807.36 / $897.07 / $1,650.78