go back

Utah 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
$21.06 / $30.42 / $39.76
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.06 / $39.27 / $251.54
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 / $46.70 / $69.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $47.73 / $62.04
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.25 / $63.85 / $63.85
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.36 / $45.77 / $68.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.54 / $32.61 / $38.31