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Maryland 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
$19.22 / $120.96 / $125.75
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.66 / $37.04 / $58.56
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $51.21
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 / $46.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.44 / $74.91 / $107.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.66 / $37.36 / $59.57
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.17 / $39.17 / $52.44