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Oklahoma 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
$616.14 / $616.14 / $616.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$593.32 / $616.14 / $694.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.52 / $723.52 / $723.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.16 / $723.52 / $723.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$622.99 / $848.06 / $6,035.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.10 / $622.94 / $1,319.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$385.10 / $586.96 / $869.29