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Missouri 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
$100.24 / $100.24 / $133.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.92 / $103.88 / $158.56
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$191.48 / $201.05 / $883.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.18 / $106.22 / $154.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $153.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $78.42 / $119.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.84 / $154.97 / $899.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.05 / $95.52 / $232.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.08 / $85.76 / $153.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.05 / $95.52 / $145.38