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Wyoming 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
Professional
Modifier
Low / Median / High Price
$108.92 / $108.92 / $170.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$189.94 / $189.94 / $189.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$189.94 / $189.94 / $189.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.42 / $107.42 / $210.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.42 / $78.42 / $107.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.75 / $85.00 / $85.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.51 / $85.76 / $95.21