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Missouri rates for HCPCS L3670

Shoulder orthosis (SO), acromio/clavicular (canvas and webbing type), prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2.24 / $47.86 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $89.13 / $251.19
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $125.89 / $169.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$169.82 / $169.82 / $588.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $83.18 / $154.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $87.10 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $63.10 / $87.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.18 / $128.82 / $676.08
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $83.18 / $870.96
Qualchoice
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.54 / $131.83 / $131.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $74.13 / $117.49