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Utah rates for HCPCS L3678

Shoulder orthosis (SO), shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $79.43 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $97.72 / $97.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $95.50 / $95.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $69.18 / $95.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $44.67 / $218.78
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $190.55 / $229.09