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Illinois 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
$946.92 / $946.92 / $946.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$740.02 / $946.92 / $1,473.86
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,202.15 / $3,725.65 / $15,851.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,187.43 / $1,400.16 / $1,400.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.78 / $1,191.78 / $2,016.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $1,191.78 / $2,135.63
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,565.97 / $2,026.55 / $2,426.06
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,395.02 / $2,395.02 / $2,395.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.22 / $919.12 / $1,627.51