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Idaho 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
$708.53 / $1,574.51 / $1,574.51
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,127.82 / $1,191.78 / $1,191.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $870.00 / $1,227.53
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.05 / $1,266.61 / $1,798.13
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,618.32 / $1,708.22 / $1,798.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $1,343.33 / $1,618.32
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,574.51 / $1,755.99 / $2,633.99
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.69 / $1,303.76 / $1,888.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$759.14 / $821.06 / $1,256.45