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Pennsylvania 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
$18.68 / $146.91 / $422.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.14 / $61.62 / $221.22
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.12 / $112.31 / $179.69
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.02 / $149.74 / $149.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.64 / $86.64 / $147.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.25 / $63.25 / $129.44
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.99 / $147.82 / $280.86
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.49 / $57.74 / $608.70
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.12 / $108.47 / $127.44
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.68 / $146.91 / $422.46
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.14 / $66.95 / $120.17
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.10 / $61.30 / $291.20
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.64 / $86.64 / $147.82
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.25 / $63.25 / $144.38
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.55 / $142.52 / $142.52
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.55 / $142.52 / $142.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.53 / $74.70 / $135.04