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Washington 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

Facilitymedian $1,778 · 10th–90th $1,202$4,3650%20%10th90th$1,778Professionalmedian $1,202 · 10th–90th $794$2,6300%20%10th90th$1,202$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,202.26 / $2,884.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $977.24 / $1,621.81
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,737.80 / $1,737.80
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,202.26 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $870.96 / $1,202.26
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,047.13 / $2,454.71 / $5,011.87
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $2,137.96 / $3,801.89
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $1,380.38 / $1,513.56
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,737.80 / $1,778.28
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,778.28 / $2,818.38
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $2,630.27 / $3,630.78
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $1,479.11 / $1,737.80
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,548.82 / $1,995.26
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$812.83 / $2,691.53 / $2,691.53
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $891.25 / $1,548.82
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,288.25 / $2,754.23