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Nebraska 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
$822.53 / $822.53 / $822.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$822.53 / $822.53 / $1,068.06
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.59 / $1,246.97 / $1,259.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.52 / $1,418.78 / $1,418.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.52 / $1,418.78 / $2,187.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$822.53 / $1,411.80 / $6,035.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.11 / $643.47 / $1,009.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,414.63 / $1,418.78 / $1,787.61
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,162.00 / $1,676.74 / $2,922.92
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,509.07 / $1,539.25 / $2,683.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.51 / $643.47 / $890.15