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Texas 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
$45.89 / $48.49 / $50.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.36 / $49.41 / $71.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,456.92 / $5,821.21 / $8,577.84
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.37 / $102.37 / $102.37
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
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 / $54.79
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$472.60 / $489.82 / $489.82
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.45 / $650.47 / $755.25
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.33 / $81.62 / $148.99
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.19 / $44.33 / $81.62
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.13 / $94.65 / $123.36
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.33 / $75.05 / $142.60
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.79 / $54.79 / $54.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.18 / $57.39 / $107.79
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.66 / $93.66 / $155.11