go back

Utah rates for HCPCS L3650

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

Facilitymedian $34 · 10th–90th $5–$400%10%20%10th90th$34Professionalmedian $47 · 10th–90th $29–$2450%10%10th90th$47$5.0$10.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5.25 / $32.36 / $39.81
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $43.65 / $245.47
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $46.77 / $46.77
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $33.88 / $46.77
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $47.86 / $61.66
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $66.07 / $66.07
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $46.77 / $74.13
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $70.79
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $66.07 / $85.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $32.36 / $43.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $32.36 / $64.57