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Mississippi 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
$49.79 / $49.79 / $79.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.79 / $58.44 / $84.51
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$175.35 / $175.35 / $192.89
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.00 / $167.00 / $167.00
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 / $75.05
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.00 / $21.25 / $50.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $50.90 / $86.73