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Maine 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
Professional
Modifier
Low / Median / High Price
$82.07 / $114.00 / $114.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.05 / $216.42 / $401.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.86 / $105.86 / $106.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $78.42 / $107.42
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.07 / $152.07 / $152.07
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.57 / $114.00 / $114.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.62 / $85.00 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.47 / $93.70 / $215.48