go back

Maine 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
Professional
Modifier
Low / Median / High Price
$604.73 / $767.88 / $767.88
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,125.15 / $1,457.74 / $2,702.19
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.33 / $712.33 / $752.32
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 / $528.16 / $723.52
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,024.28 / $1,024.28 / $1,024.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$712.33 / $767.88 / $767.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.08 / $650.14 / $1,451.41