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Alaska 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
$1,540.34 / $1,540.34 / $1,540.34
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 / $1,191.78 / $1,227.53
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.05 / $530.05 / $530.05
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,708.22 / $1,708.22 / $2,697.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.05 / $530.05 / $1,191.78
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $1,227.53 / $2,107.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$869.08 / $1,719.39 / $3,971.73