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North Carolina 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
$169.41 / $169.41 / $292.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.87 / $169.41 / $169.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.12 / $186.14 / $353.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.59 / $145.10 / $154.78
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 / $107.42 / $223.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.36 / $169.41 / $220.23
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.00 / $108.00 / $131.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.40 / $225.40 / $346.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.08 / $85.00 / $91.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.66 / $95.66 / $148.74
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.30 / $899.40 / $899.40
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$968.61 / $968.61 / $1,408.65