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Arizona rates for HCPCS L3650

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.84 / $31.84 / $31.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.04 / $39.27 / $76.34
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.89 / $82.68 / $149.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.22 / $76.30 / $103.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.70 / $46.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $34.09 / $46.70
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.06 / $58.25 / $352.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.45 / $32.61 / $49.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.45 / $32.61 / $49.13