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Utah rates for HCPCS L3671

Shoulder orthosis (SO), shoulder joint design, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $281.84 / $281.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $524.81 / $891.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $398.11 / $562.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $724.44 / $933.25
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $870.96 / $1,513.56
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $707.95 / $1,023.29
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,000.00 / $1,023.29
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,023.29 / $1,174.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $436.52 / $575.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $436.52 / $630.96