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Maine rates for HCPCS L3670

Shoulder orthosis (SO), acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.53 / $209.24 / $211.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.14 / $60.07 / $75.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.87 / $143.65 / $266.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.20 / $83.20 / $83.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.64 / $86.64 / $91.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.25 / $63.25 / $86.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.93 / $100.93 / $100.93
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.78 / $187.53 / $211.61
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.14 / $54.46 / $75.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.92 / $62.19 / $143.03