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California 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
$10.35 / $39.27 / $251.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.04 / $39.27 / $195.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.36 / $59.27 / $69.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.82 / $122.85 / $276.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.54 / $39.58 / $73.48
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.60 / $103.21 / $184.30
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.12 / $115.67 / $269.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.33 / $46.70 / $69.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $34.09 / $50.02
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.97 / $43.18 / $95.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.31 / $61.03 / $135.13
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.75 / $352.17 / $414.11
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$425.75 / $435.96 / $563.17
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.88 / $146.88 / $146.88
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.06 / $71.65 / $87.18
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $46.70 / $69.00
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.55 / $164.55 / $164.55
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.97 / $61.17 / $69.73
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.09 / $87.18 / $87.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.16 / $32.67 / $90.88