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South Carolina rates for HCPCS L3675

Shoulder Orthosis Vest Type Abduction Restrainer Canvas Webbing Type Or Equal Prefabricated Off- The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.76 / $95.76 / $95.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.73 / $95.76 / $169.41
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.45 / $164.45 / $164.45
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.00 / $116.00 / $203.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.99 / $107.42 / $118.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $107.42 / $153.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.10 / $139.00 / $303.85
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.00 / $108.00 / $117.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.74 / $130.74 / $130.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.13 / $91.26 / $129.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.34 / $92.91 / $121.36