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South 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
$916.78 / $916.78 / $916.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$879.64 / $916.78 / $1,621.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,852.28 / $1,852.28 / $2,229.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.78 / $1,191.78 / $1,315.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $1,113.89 / $1,191.78
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$824.26 / $1,355.41 / $2,909.00
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,355.41 / $1,355.41 / $1,355.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,251.64 / $1,251.64 / $1,251.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.05 / $882.89 / $1,113.89