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Wyoming 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
Professional
Modifier
Low / Median / High Price
$733.82 / $733.82 / $1,147.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,279.68 / $1,279.68 / $1,279.68
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,279.68 / $1,279.68 / $1,279.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.52 / $723.52 / $1,418.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.16 / $528.16 / $723.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.57 / $577.66 / $641.30