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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
$616.60 / $616.60 / $616.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $691.83 / $1,071.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $524.81 / $1,412.54
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $851.14 / $4,073.80
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $616.60 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$575.44 / $1,318.26 / $1,348.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $575.44 / $870.96