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South Carolina 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
$42.72 / $42.72 / $42.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.72 / $42.72 / $85.75
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.43 / $119.43 / $119.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.57 / $75.05 / $75.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.79 / $54.79 / $76.53
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.72 / $52.97 / $132.47
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.72 / $103.72 / $103.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.31 / $54.53 / $86.50