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Shoulder Orthosis (SO), Figure of Eight Abduction Restrainer

Arizona rates for HCPCS L3650

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

Rates data updated July 2026.

Facilitymedian $74 · 10th–90th $23$1740%10%10th90th$74Professionalmedian $39 · 10th–90th $30$1820%20%40%10th90th$39$0.1$0.5$2.0$10.0$50.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$31.62
Median
$31.62
Typical High
$31.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$38.90
Typical High
$186.21
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$50.12
BCBS
Setting
Facility
Modifier
Global
Typical Low
$24.55
Median
$97.72
Typical High
$190.55
BCBS
Setting
Professional
Modifier
Global
Typical Low
$67.61
Median
$89.13
Typical High
$181.97
Cigna
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$46.77
Cigna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$33.88
Typical High
$46.77
Medica
Setting
Facility
Modifier
Global
Typical Low
$20.89
Median
$58.88
Typical High
$354.81
Medica
Setting
Professional
Modifier
Global
Typical Low
$26.92
Median
$32.36
Typical High
$426.58
United
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$70.79
Typical High
$89.13
United
Setting
Professional
Modifier
Global
Typical Low
$25.12
Median
$32.36
Typical High
$48.98