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Pennsylvania rates for HCPCS L3660

Shoulder orthosis (SO), figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.81 / $319.27 / $319.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.50 / $51.59 / $74.29
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.21 / $102.21 / $102.21
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.28 / $113.31 / $113.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.80 / $70.80 / $115.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.68 / $51.68 / $131.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.68 / $115.96 / $220.32
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.12 / $30.12 / $34.60
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.51 / $80.75 / $90.65
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.89 / $319.27 / $319.27
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.50 / $51.29 / $92.76
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.00 / $78.50 / $228.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.80 / $70.80 / $115.96
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.68 / $51.68 / $131.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.34 / $107.85 / $107.85
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.34 / $107.85 / $110.37
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.38 / $56.77 / $99.00