go back

Minnesota 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 / $67.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.47 / $67.30 / $84.31
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.12 / $151.12 / $889.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.90 / $151.12 / $151.12
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.05 / $279.33 / $775.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.25 / $107.33 / $128.59
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.83 / $265.41 / $610.88
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.25 / $101.25 / $108.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.33 / $129.03 / $472.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $58.51 / $128.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $58.51 / $117.77