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North Dakota 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
$141.51 / $141.51 / $141.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.17 / $133.72 / $141.51
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.86 / $215.02 / $220.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.13 / $225.36 / $283.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.78 / $141.51 / $899.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.50 / $97.04 / $197.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.00 / $85.00 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.15 / $100.06 / $192.46