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Florida 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
$80.16 / $88.84 / $101.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.87 / $93.52 / $169.41
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 / $121.82
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.81 / $118.81 / $118.81
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.42 / $123.30 / $193.47
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.44 / $103.76 / $114.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.13 / $85.00 / $102.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.51 / $94.51 / $123.03
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.76 / $103.76 / $105.86