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Louisiana 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
$38.72 / $41.11 / $55.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.07 / $39.83 / $47.57
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.49 / $79.19 / $79.19
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.37 / $106.55 / $149.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.53 / $50.87 / $50.87
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.70 / $69.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $34.09 / $69.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.09 / $87.18 / $87.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.75 / $33.33 / $50.26