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Missouri 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
$5.50 / $10.44 / $54.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.27 / $42.11 / $64.27
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.21 / $58.21 / $58.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.61 / $81.48 / $358.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.29 / $39.58 / $62.79
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 / $49.79
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.45 / $62.55 / $352.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.02 / $38.72 / $94.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.18 / $87.18 / $104.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.81 / $38.06 / $56.10