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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
$812.83 / $812.83 / $812.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $812.83 / $5,495.41
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,258.93 / $1,258.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $1,445.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,513.56 / $2,238.72
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,412.54 / $6,025.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $645.65 / $1,071.52
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,778.28 / $3,235.94
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,238.72 / $3,235.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $676.08 / $1,348.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $645.65 / $977.24