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Iowa 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
$67.30 / $67.30 / $84.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.88 / $54.34 / $86.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.05 / $75.05 / $75.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.25 / $126.56 / $163.95
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$152.85 / $157.19 / $168.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.34 / $200.19 / $472.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.37 / $68.16 / $199.50
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$108.76 / $129.56 / $205.01
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.23 / $163.95 / $223.34
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.04 / $125.52 / $133.16
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.86 / $57.82 / $137.87
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$326.89 / $326.89 / $326.89
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.25 / $326.89 / $326.89