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Indiana 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
$95.26 / $95.26 / $192.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.60 / $97.03 / $103.37
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.35 / $144.35 / $144.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$152.04 / $172.25 / $192.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.88 / $106.22 / $146.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.10 / $211.71 / $288.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.59 / $211.71 / $259.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $192.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $107.42 / $197.43
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.45 / $92.91 / $136.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.18 / $93.02 / $130.16