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Louisiana 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
$1,000.99 / $1,062.58 / $1,431.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$879.64 / $1,062.58 / $1,154.99
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,612.06 / $2,753.96 / $3,871.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,099.38 / $1,314.99 / $1,314.99
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $1,191.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.38 / $854.32 / $1,265.23