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Kentucky 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
$62.49 / $99.44 / $103.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.49 / $95.59 / $104.42
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.61 / $143.61 / $144.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.44 / $193.47 / $203.34
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.50 / $93.88 / $106.22
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.10 / $269.44 / $309.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.80 / $240.58 / $319.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $226.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $107.42 / $926.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.10 / $123.30 / $154.12
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.68 / $85.00 / $100.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.34 / $92.91 / $127.55