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Minnesota 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
$131.83 / $131.83 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $100.00 / $158.49
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $190.55 / $281.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$154.88 / $190.55 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $724.44 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $257.04 / $281.84
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $707.95 / $1,348.96
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.87 / $223.87 / $302.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $190.55 / $389.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $85.11 / $234.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1.38 / $85.11 / $234.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $95.50 / $239.88