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Montana rates for HCPCS L3675

Shoulder orthosis (SO), vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf

Facilitymedian $191 · 10th–90th $120–$2400%20%10th90th$191Professionalmedian $112 · 10th–90th $65–$2040%10%10th90th$112$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $107.15 / $162.18
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $204.17 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $204.17 / $204.17
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $190.55 / $371.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $190.55 / $371.54
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $151.36 / $234.42
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $154.88 / $204.17
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $91.20 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $85.11 / $131.83