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Indiana rates for HCPCS L3650

Shoulder Orthosis Figure Of Eight Design Abduction Restrainer Prefabricated Off-The-Shelf(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.83 / $102.14 / $351.33
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.17 / $39.11 / $42.87
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.36 / $37.36 / $59.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.43 / $70.72 / $79.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.29 / $39.58 / $54.62
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.09 / $82.97 / $110.63
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.17 / $86.92 / $106.68
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.70 / $79.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $46.70 / $81.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.62 / $104.62 / $104.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.75 / $37.10 / $51.73