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Maine 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
Professional
Modifier
Low / Median / High Price
$77.62 / $102.33 / $288.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $223.87 / $257.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $134.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $107.15 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $77.62 / $107.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $194.98
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $114.82 / $288.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $85.11 / $85.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $104.71 / $181.97