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Arizona 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
Professional
Modifier
Low / Median / High Price
$55.36 / $75.13 / $169.41
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.62 / $144.62 / $144.62
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.31 / $178.14 / $322.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.28 / $164.37 / $223.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $107.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $78.42 / $223.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.36 / $130.88 / $899.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.51 / $85.76 / $129.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $85.00 / $95.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.51 / $85.76 / $123.03