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Arkansas rates for HCPCS L3674

Shoulder orthosis (SO), abduction positioning (airplane design), thoracic component and support bar, with or without nontorsion joint/turnbuckle, may include soft interface, straps, custom fabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.27 / $724.27 / $724.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$539.92 / $724.27 / $724.27
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$219,999.78 / $539,999.46 / $949,999.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,124.91 / $1,488.85 / $1,654.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,265.07 / $1,265.07 / $1,303.17
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,265.07 / $1,265.07 / $1,265.07
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.52 / $723.52 / $1,042.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.16 / $723.52 / $1,018.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.10 / $586.96 / $916.16