go back

Arkansas 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
$1,029.44 / $1,029.44 / $1,029.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$767.44 / $1,029.44 / $1,029.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,598.88 / $2,116.17 / $2,351.30
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,798.13 / $1,798.13 / $1,852.28
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,798.13 / $1,798.13 / $1,798.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.78 / $1,191.78 / $1,481.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $1,191.78 / $1,446.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.38 / $834.29 / $1,116.01