go back

Washington, DC rates for HCPCS L3677

Shoulder Orthosis Shoulder Joint Design Without Joints May Include Soft Interface Straps Pre- Fabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise Customized To Fit A Specific Patient By An Individual With Expertise(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.23 / $47.23 / $47.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.23 / $47.23 / $47.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.79 / $54.79 / $54.79
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.92 / $66.92 / $211.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.20 / $70.59 / $106.06