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Shoulder Orthosis (SO), Figure of Eight Abduction Restrainer

Washington rates for HCPCS L3650

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

Rates data updated July 2026.

Facilitymedian $69 · 10th–90th $47$1510%20%10th90th$69Professionalmedian $58 · 10th–90th $34$1740%10%10th90th$58$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
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$51.29
Typical High
$112.20
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$46.77
Typical High
$194.98
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$66.07
Median
$67.61
Typical High
$69.18
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$77.62
Cigna
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$46.77
Typical High
$69.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$33.88
Typical High
$46.77
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$45.71
Median
$97.72
Typical High
$199.53
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$81.28
Typical High
$151.36
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$67.61
Typical High
$74.13
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$67.61
Typical High
$69.18
Pacific Source
Setting
Professional
Modifier
Global
Typical Low
$66.07
Median
$69.18
Typical High
$81.28
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$61.66
Median
$102.33
Typical High
$138.04
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$67.61
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$67.61
Typical High
$69.18
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$77.62
United
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$89.13
Typical High
$107.15
United
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$38.02
Typical High
$64.57
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$28.84
Median
$60.26
Typical High
$107.15