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Shoulder Orthosis (SO), Figure of Eight Abduction Restrainer

Utah rates for HCPCS L3650

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

Rates data updated July 2026.

Facilitymedian $34 · 10th–90th $5$430%10%20%10th90th$34Professionalmedian $44 · 10th–90th $30$2450%10%10th90th$44$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
Setting
Facility
Modifier
Global
Typical Low
$5.25
Median
$33.88
Typical High
$39.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$41.69
Typical High
$245.47
Cigna
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$46.77
Cigna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$33.88
Typical High
$46.77
Molina
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$47.86
Typical High
$61.66
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$66.07
Typical High
$66.07
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$46.77
Typical High
$77.62
Select Health
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$66.07
Typical High
$66.07
Select Health
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$66.07
Typical High
$70.79
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$46.77
Median
$66.07
Typical High
$85.11
United
Setting
Facility
Modifier
Global
Typical Low
$26.92
Median
$34.67
Typical High
$60.26
United
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$32.36
Typical High
$50.12