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Indiana 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
$641.51 / $641.51 / $1,296.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.84 / $643.89 / $696.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.95 / $1,160.05 / $1,296.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$601.85 / $752.32 / $1,038.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.38 / $1,425.75 / $1,944.21
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,101.72 / $1,425.75 / $1,749.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.52 / $723.52 / $1,296.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.16 / $723.52 / $1,329.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.10 / $625.79 / $916.16