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Virginia 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
$76.87 / $92.87 / $92.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.02 / $92.87 / $109.91
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.82 / $187.82 / $199.46
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.22 / $106.22 / $133.74
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.85 / $104.85 / $128.38
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 / $78.42 / $125.49
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.47 / $169.04 / $225.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.36 / $108.66 / $209.86
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.00 / $234.78 / $312.85
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.90 / $142.16 / $235.18
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.90 / $142.16 / $235.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.59 / $85.00 / $91.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.29 / $93.70 / $141.13