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Wisconsin 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 $1,862 · 10th–90th $1,660$3,3880%20%40%10th90th$1,862Professionalmedian $1,202 · 10th–90th $832$2,8180%20%10th90th$1,202$2.0$10.0$50.0$200.0$1.0K$5.0K

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
$933.25 / $933.25 / $933.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $933.25 / $1,348.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $1,862.09 / $3,090.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $1,737.80 / $2,089.30
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $4,365.16 / $9,332.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $2,691.53 / $3,548.13
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,513.56 / $2,344.23
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $1,778.28 / $2,238.72
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$933.25 / $1,862.09 / $8,511.38
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$812.83 / $954.99 / $2,041.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $1,202.26
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,951.21 / $2,951.21 / $2,951.21
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $2,137.96 / $3,715.35
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,818.38 / $5,128.61
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $3,715.35 / $8,511.38
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,737.80 / $9,332.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $954.99 / $1,862.09
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $912.01 / $1,548.82