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Massachusetts 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
$549.54 / $549.54 / $549.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $645.65 / $1,174.90
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,025.60 / $6,025.60
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $676.08 / $1,778.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $1,659.59 / $2,187.76
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $977.24 / $977.24
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $741.31
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $4,897.79 / $9,772.37
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,698.24
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $6,025.60 / $6,025.60
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $676.08 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.91 / $741.31 / $1,584.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $758.58 / $1,096.48