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Missouri 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
$959.71 / $959.71 / $1,278.57
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$946.92 / $994.61 / $1,518.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,833.27 / $1,924.93 / $8,462.37
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$911.20 / $1,002.36 / $1,507.94
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 / $870.00 / $1,227.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$916.78 / $1,491.92 / $8,579.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$680.25 / $914.59 / $2,228.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$642.88 / $914.59 / $1,586.79