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Maine 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
Professional
Modifier
Low / Median / High Price
$35.40 / $40.85 / $49.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.06 / $93.37 / $173.08
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.58 / $41.73 / $41.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.70 / $59.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $34.09 / $46.70
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.61 / $65.61 / $65.61
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.27 / $45.63 / $49.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.95 / $40.43 / $92.97