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Michigan 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
$109.91 / $109.91 / $359.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.29 / $109.91 / $109.91
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$291.30 / $580.38 / $1,057.07
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.84 / $192.46 / $259.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$122.08 / $125.10 / $125.76
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.97 / $153.97 / $153.97
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $153.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.42 / $107.42 / $223.13
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$109.91 / $139.07 / $359.90
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.00 / $139.07 / $202.08
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.78 / $142.41 / $163.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.42 / $85.00 / $108.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.15 / $90.37 / $136.03