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Kentucky 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
$23.77 / $33.92 / $38.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.77 / $37.61 / $42.44
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.36 / $59.27 / $59.27
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.08 / $65.98 / $69.36
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.86 / $38.29 / $39.58
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.49 / $93.05 / $125.38
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.98 / $89.09 / $110.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.70 / $86.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.44 / $46.70 / $115.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.48 / $42.06 / $52.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.95 / $32.92 / $49.91