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Washington rates for HCPCS L3650

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

Facilitymedian $68 · 10th–90th $47–$1510%10%20%10th90th$68Professionalmedian $47 · 10th–90th $32–$1450%10%10th90th$47$1.0$5.0$20.0$100.0$500.0

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
$46.77 / $53.70 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $41.69 / $186.21
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $67.61 / $67.61
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $77.62
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $46.77 / $69.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $33.88 / $46.77
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $91.20 / $194.98
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $85.11 / $151.36
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $67.61 / $74.13
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $67.61 / $69.18
Pacific Source
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $69.18 / $81.28
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $102.33 / $138.04
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $67.61
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $67.61
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $77.62
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$32.36 / $89.13 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $38.02 / $61.66
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $60.26 / $107.15