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Kentucky 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
$608.50 / $669.81 / $694.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$586.29 / $669.81 / $696.17
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$811.22 / $1,303.17 / $1,369.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$583.85 / $858.37 / $858.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.38 / $1,814.60 / $2,087.37
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,238.01 / $1,620.18 / $2,150.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.52 / $723.52 / $1,527.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.16 / $723.52 / $6,216.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.42 / $626.45 / $962.76