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Kansas 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
$1,068.06 / $1,068.06 / $1,068.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.11 / $699.76 / $1,068.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,177.76 / $1,284.99 / $1,362.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,275.46 / $1,275.46 / $1,275.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.52 / $723.52 / $723.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.16 / $723.52 / $1,878.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.76 / $1,039.48 / $6,035.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.10 / $643.47 / $1,646.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.18 / $643.47 / $916.16