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Tennessee 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
$586.29 / $586.29 / $640.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$550.53 / $604.73 / $1,097.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.44 / $1,172.84 / $1,172.84
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 / $528.16 / $723.52
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,759.28 / $6,035.75 / $6,035.75
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,525.74 / $6,525.74 / $9,488.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$433.42 / $635.92 / $869.29