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Minnesota 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
$900.59 / $900.59 / $900.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.36 / $900.59 / $953.37
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,110.31 / $1,296.14 / $1,804.83
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,036.91 / $1,231.33 / $1,296.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.52 / $3,999.57 / $11,108.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,502.63 / $1,592.78 / $1,908.33
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,374.50 / $3,837.39 / $8,746.83
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,502.63 / $1,502.63 / $1,546.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$848.06 / $1,296.14 / $6,035.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.10 / $645.04 / $1,418.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.10 / $645.04 / $1,301.55