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Minnesota 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
$133.72 / $133.72 / $133.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.02 / $133.72 / $141.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.87 / $192.46 / $268.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$153.97 / $182.84 / $192.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $593.83 / $1,649.32
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.13 / $236.51 / $283.37
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$352.55 / $569.75 / $1,298.68
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.13 / $223.13 / $229.60
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.02 / $192.46 / $899.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.18 / $95.77 / $239.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.37 / $85.00 / $85.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.18 / $95.21 / $193.27