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Arizona 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
$719.25 / $916.78 / $1,621.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$431.55 / $1,558.98 / $2,818.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,078.88 / $1,438.50 / $1,959.96
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 / $2,135.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.05 / $1,028.53 / $8,579.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.35 / $821.06 / $1,236.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.09 / $821.06 / $1,177.92