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Massachusetts 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
$61.06 / $61.06 / $61.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.34 / $61.06 / $84.51
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.21 / $489.82 / $489.82
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.20 / $89.96 / $140.21
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 / $101.25
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$171.57 / $489.82 / $489.82
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.98 / $68.86 / $141.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.98 / $71.70 / $122.62