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New York 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 / $782.51 / $1,448.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$612.14 / $785.65 / $1,133.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,798.13 / $1,834.09 / $3,596.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,002.36 / $1,002.36 / $2,786.84
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,393.24 / $1,498.11 / $1,498.11
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,498.11 / $1,498.11 / $1,498.11
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
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.00 / $1,798.13 / $4,045.79
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,039.85 / $1,330.62 / $3,236.63
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,299.83 / $1,299.83 / $1,299.83
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,081.05 / $1,148.61 / $1,498.11
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.00 / $1,191.78 / $1,798.13
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $1,111.33 / $2,669.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.04 / $948.92 / $1,644.63
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$961.18 / $1,081.05 / $1,081.05
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,081.05 / $1,081.05 / $1,299.83