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Georgia rates for HCPCS L3675

Shoulder Orthosis Vest Type Abduction Restrainer Canvas Webbing Type Or Equal Prefabricated Off- The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.88 / $91.88 / $218.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.04 / $116.06 / $171.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$193.47 / $270.86 / $710.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.87 / $160.87 / $308.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.65 / $164.45 / $357.92
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.45 / $164.45 / $164.45
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 / $107.42 / $204.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.04 / $193.47 / $268.74
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.27 / $241.84 / $357.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.86 / $85.00 / $91.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.34 / $96.52 / $159.25