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North Dakota 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 / $954.99 / $954.99
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $691.83 / $954.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,445.44 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $1,862.09
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,047.13 / $6,025.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $645.65 / $1,318.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,905.46 / $1,905.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $660.69 / $1,380.38