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Louisiana 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
$104.56 / $110.99 / $149.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.45 / $110.98 / $133.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.39 / $287.67 / $404.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.83 / $137.36 / $137.36
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $153.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.62 / $85.00 / $100.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.18 / $89.24 / $132.15