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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
$891.25 / $891.25 / $891.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $691.83 / $1,071.52
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,288.25 / $1,905.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,288.25 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $4,897.79 / $11,481.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,698.24 / $1,905.46
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $4,677.35 / $9,120.11
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $2,041.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,288.25 / $2,344.23
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $575.44 / $1,412.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9.33 / $575.44 / $1,584.89
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $645.65 / $1,584.89