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Alaska rates for HCPCS L3650

Shoulder orthosis (SO), figure of eight design abduction restrainer, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.27 / $82.99 / $87.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.70 / $46.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.00 / $46.70 / $49.79
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.06 / $21.06 / $21.06
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.20 / $92.04 / $145.32
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$94.61 / $94.61 / $94.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.06 / $21.06 / $46.70
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.46 / $46.70 / $75.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.82 / $48.33 / $120.83