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Colorado 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
$108.92 / $108.92 / $108.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.02 / $108.92 / $145.68
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.50 / $218.54 / $396.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.22 / $106.22 / $114.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $153.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $78.42 / $204.89
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.36 / $108.92 / $244.70
Denver HMP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.36 / $55.36 / $55.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.99 / $243.13 / $385.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $100.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.87 / $85.76 / $129.18