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Iowa 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
$133.72 / $133.72 / $141.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.36 / $103.37 / $174.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $210.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.42 / $223.13 / $278.91
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.91 / $210.31 / $227.90
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.29 / $229.20 / $899.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $102.02 / $261.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$210.01 / $210.63 / $261.14
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.00 / $246.04 / $402.49
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.46 / $206.12 / $348.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.83 / $85.00 / $102.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.00 / $95.52 / $182.25
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.91 / $181.91 / $181.91
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.71 / $181.91 / $181.91