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Utah rates for HCPCS L3675

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

Facilitymedian $91 · 10th–90th $55–$1950%20%40%10th90th$91Professionalmedian $132 · 10th–90th $55–$8130%10%10th90th$132$50.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $107.15 / $812.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $107.15 / $107.15
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $77.62 / $107.15
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $141.25 / $186.21
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $194.98 / $194.98
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $138.04 / $208.93
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $194.98 / $199.53
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $199.53 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $85.11 / $91.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $85.11 / $144.54