go back

California 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
$55.36 / $55.36 / $541.91
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.36 / $81.73 / $372.34
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.08 / $127.72 / $166.49
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.40 / $287.93 / $596.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.88 / $106.22 / $178.99
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.60 / $222.35 / $397.05
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $249.21 / $580.48
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.78 / $107.42 / $149.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $78.42 / $153.94
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.86 / $105.43 / $206.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.69 / $131.47 / $291.12
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.33 / $899.40 / $899.40
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$968.61 / $968.61 / $1,408.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$396.59 / $396.59 / $396.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.36 / $162.31 / $193.46
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $107.42 / $178.77
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.50 / $354.50 / $354.50
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.86 / $149.36 / $150.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$14.17 / $77.87 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.29 / $85.76 / $171.90