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Oklahoma 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
$91.48 / $91.48 / $134.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.09 / $88.09 / $91.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.40 / $169.40 / $169.40
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 / $153.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.36 / $117.80 / $899.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.18 / $92.21 / $191.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.08 / $85.76 / $103.34
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.18 / $87.23 / $123.03