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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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$911.85 / $911.85 / $1,842.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.78 / $915.20 / $989.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,455.43 / $1,648.88 / $1,842.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$898.74 / $1,002.36 / $1,353.18
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,389.21 / $2,026.55 / $2,763.48
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,565.97 / $2,026.55 / $2,487.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.78 / $1,191.78 / $1,842.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $1,191.78 / $1,889.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.38 / $882.89 / $1,245.74