go back

New Jersey 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
$430.25 / $430.25 / $430.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$430.25 / $550.53 / $696.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.52 / $723.52 / $1,265.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.16 / $528.16 / $1,107.74
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,155.74 / $1,163.85 / $1,657.24
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.42 / $1,265.07 / $1,265.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$569.86 / $631.13 / $1,265.07