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Michigan 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
$741.31 / $741.31 / $741.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $691.83 / $891.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.59 / $3,890.45 / $7,413.10
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,288.25 / $1,348.96
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $851.14
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 / $724.44 / $1,513.56
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $2,454.71 / $2,754.23
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $1,023.29 / $1,584.89
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $724.44 / $741.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $1,047.13 / $1,584.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $602.56 / $977.24