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Missouri 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
$675.21 / $675.21 / $899.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$666.19 / $699.76 / $1,068.06
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,289.80 / $1,354.29 / $5,953.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$629.41 / $752.32 / $1,059.83
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 / $745.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$699.76 / $1,096.33 / $6,035.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.38 / $643.47 / $1,567.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.30 / $643.47 / $1,065.16