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Oklahoma 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
$875.76 / $875.76 / $1,290.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$843.32 / $875.76 / $987.30
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
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.05 / $1,112.39 / $8,579.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.38 / $882.80 / $1,831.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$547.38 / $821.06 / $1,177.92