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Vermont 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
Professional
Modifier
Low / Median / High Price
$877.47 / $877.47 / $1,012.47
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 / $1,227.53
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.78 / $1,191.78 / $1,191.78
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $1,191.78 / $1,227.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.04 / $1,065.16 / $2,078.73