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Delaware 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
$77.30 / $77.30 / $88.65
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 / $153.94
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.83 / $126.83 / $126.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $85.00 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.05 / $93.70 / $141.13