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Massachusetts 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
$82.07 / $82.07 / $82.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.02 / $82.07 / $120.29
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.04 / $556.72 / $899.40
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.87 / $136.02 / $183.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.02 / $190.53 / $263.77
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 / $223.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.07 / $152.07 / $159.66
Health New England
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.42 / $114.42 / $114.42
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$390.69 / $899.40 / $899.40
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.47 / $93.70 / $183.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.14 / $85.00 / $91.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.37 / $93.70 / $183.42