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Indiana 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

Facilitymedian $1,862 · 10th–90th $912–$2,2910%50%10th90th$1,862Professionalmedian $955 · 10th–90th $813–$1,5140%20%40%10th90th$955$2.0$10.0$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$912.01 / $912.01 / $912.01
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $912.01 / $1,513.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,862.09 / $2,344.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,000.00 / $1,819.70
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,398.83 / $2,754.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,202.26 / $1,862.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $870.96 / $1,995.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$630.96 / $1,071.52 / $1,513.56
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $912.01 / $1,318.26