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Kansas 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
$1,518.09 / $1,518.09 / $1,518.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.05 / $994.61 / $1,518.09
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,315.25 / $1,434.99 / $1,522.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,424.35 / $1,424.35 / $1,424.35
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 / $1,191.78 / $2,669.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.05 / $1,477.46 / $8,579.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.38 / $914.59 / $1,755.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.38 / $914.59 / $1,224.93