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Nebraska 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
$28.42 / $49.49 / $171.14
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.17 / $49.49 / $186.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.21 / $58.21 / $58.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.20 / $75.03 / $75.79
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $85.37 / $85.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.70 / $85.37 / $131.63
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.59 / $84.95 / $352.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.81 / $38.72 / $72.04
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.13 / $85.37 / $107.56
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.00 / $99.72 / $175.86
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.80 / $92.62 / $161.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.09 / $74.09 / $74.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.81 / $38.72 / $49.13