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New Jersey rates for HCPCS L3677

Shoulder orthosis (SO), shoulder joint design, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.37 / $55.37 / $55.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.12 / $53.85 / $79.36
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
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.58 / $112.58 / $112.58
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.64 / $134.93 / $158.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.31 / $67.45 / $102.58