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Pennsylvania 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
$11.30 / $78.66 / $135.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.34 / $36.07 / $57.78
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.04 / $74.91 / $74.91
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.70 / $75.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $34.09 / $69.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.08 / $75.09 / $142.66
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$18.07 / $57.74 / $312.25
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.58 / $59.93 / $63.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.30 / $94.46 / $135.27
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.69 / $36.07 / $55.80
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.80 / $32.60 / $147.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.70 / $75.09
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $34.09 / $91.50
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.81 / $71.30 / $71.30
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.81 / $71.30 / $75.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.09 / $87.18 / $104.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.64 / $37.70 / $62.29