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Louisiana 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
$704.25 / $747.59 / $1,007.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.87 / $747.59 / $812.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,134.17 / $1,937.55 / $2,723.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$773.46 / $925.17 / $925.17
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
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 / $723.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.10 / $618.61 / $920.97