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Montana 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
$501.19 / $794.33 / $1,174.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,380.38 / $1,380.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $1,122.02 / $1,380.38
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,288.25 / $2,511.89
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,288.25 / $2,511.89
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,288.25 / $1,513.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,023.29 / $1,380.38
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $724.44 / $758.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $575.44 / $660.69