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Minnesota 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
$54.90 / $54.90 / $54.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.30 / $39.27 / $54.90
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.69 / $79.02 / $110.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.22 / $75.06 / $79.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $244.15 / $678.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.50 / $96.99 / $116.21
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.94 / $234.25 / $533.95
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.50 / $91.50 / $94.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.69 / $79.02 / $352.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.75 / $36.43 / $85.37
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.09 / $87.18 / $104.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.75 / $32.85 / $79.34