go back

New Hampshire 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
$69.30 / $69.30 / $83.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.03 / $61.06 / $69.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.66 / $93.66 / $93.66
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.15 / $60.25 / $114.43