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Idaho 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
$60.90 / $164.46 / $164.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $117.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $107.42 / $114.51
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.36 / $132.30 / $187.82
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.04 / $178.43 / $187.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $138.61 / $165.08
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.46 / $183.42 / $275.13
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.47 / $136.15 / $197.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $91.26 / $100.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.29 / $85.76 / $145.54