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Mississippi 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
$108.42 / $108.42 / $172.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.02 / $110.99 / $172.80
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.10 / $145.10 / $161.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.93 / $149.93 / $149.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$149.93 / $149.93 / $149.93
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 / $153.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.45 / $85.00 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.18 / $89.24 / $144.08