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Shoulder Orthosis (SO), Figure of Eight Abduction Restrainer

South Dakota rates for HCPCS L3650

Shoulder orthosis (SO), figure of eight design abduction restrainer, prefabricated, off-the-shelf

Rates data updated July 2026.

Facilitymedian $55 · 10th–90th $17$890%20%10th90th$55Professionalmedian $55 · 10th–90th $39$1150%10%10th90th$55$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$16.98
Median
$16.98
Typical High
$47.86
Aetna
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$48.98
Typical High
$61.66
Avera
Setting
Facility
Modifier
Global
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$87.10
Cigna
Setting
Professional
Modifier
Global
Typical Low
$91.20
Median
$91.20
Typical High
$114.82
Medica
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$70.79
Typical High
$123.03
Medica
Setting
Professional
Modifier
Global
Typical Low
$26.30
Median
$50.12
Typical High
$426.58
Midlands
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$85.11
Typical High
$85.11
Midlands
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$87.10
Typical High
$87.10
Midlands
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$117.49
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$66.07
Typical High
$87.10
United
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$38.02
Typical High
$54.95
United
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$50.12
Typical High
$93.33
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$75.86
Median
$75.86
Typical High
$75.86