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Ohio 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
$989.53 / $989.53 / $2,886.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$865.98 / $989.53 / $1,133.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,729.94 / $2,026.55 / $5,250.61
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$898.74 / $1,002.36 / $2,395.01
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,381.74 / $1,842.32 / $2,487.13
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,203.98 / $1,667.05 / $3,944.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.78 / $1,191.78 / $2,170.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.00 / $870.00 / $1,230.98
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,191.78 / $1,191.78 / $1,191.78
Medical Mutual of Ohio
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
$612.74 / $878.14 / $1,237.08