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Virginia rates for HCPCS L3650

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$22.67 / $30.10 / $37.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.34 / $37.04 / $45.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.91 / $74.91 / $79.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.58 / $39.58 / $51.68
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $40.00 / $51.21
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 / $34.09 / $50.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.44 / $67.42 / $89.89
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.06 / $46.07 / $84.06
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.00 / $93.64 / $124.78
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.21 / $56.53 / $93.79
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.21 / $56.53 / $93.79
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.18 / $87.18 / $104.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.61 / $37.36 / $56.30