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Illinois 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
$50.47 / $50.47 / $565.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.38 / $50.47 / $78.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,084.59 / $2,320.00 / $4,645.80
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.00 / $290.00 / $290.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.05 / $75.05 / $75.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.79 / $54.79 / $126.56
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.30 / $187.20 / $200.25
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.18 / $59.98 / $103.92