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Wyoming 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
$47.50 / $47.50 / $47.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.61 / $36.61 / $57.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.85 / $63.85 / $63.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.85 / $63.85 / $63.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $46.70 / $85.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $34.09 / $46.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.48 / $32.61 / $36.21