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Utah rates for HCPCS L3975

Shoulder Elbow Wrist Hand Finger Orthosis 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
$530.05 / $530.05 / $530.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$530.05 / $614.05 / $5,188.07
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 / $1,227.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$843.00 / $1,359.68 / $1,767.58
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,630.88 / $1,818.86 / $1,818.86
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,035.72 / $1,303.76 / $1,955.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.82 / $813.74 / $987.47