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Arkansas rates for HCPCS L3675

Shoulder orthosis (SO), vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.54 / $107.54 / $107.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.16 / $107.54 / $107.54
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.77 / $154.77 / $154.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.01 / $221.05 / $245.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.82 / $187.82 / $193.47
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.82 / $187.82 / $187.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $154.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $107.42 / $151.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.08 / $85.00 / $85.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.18 / $87.14 / $116.31