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Wisconsin rates for HCPCS L3650

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

Facilitymedian $89 · 10th–90th $74$2000%50%10th90th$89Professionalmedian $55 · 10th–90th $34$1260%10%20%10th90th$55$0.1$0.5$2.0$10.0$50.0$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $151.36 / $331.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $38.90 / $61.66
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $131.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $74.13 / $91.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $186.21 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $114.82 / $151.36
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $64.57 / $100.00
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $95.50 / $117.49
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $79.43 / $354.81
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $39.81 / $87.10
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $58.88 / $83.18
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $91.20 / $158.49
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $120.23 / $204.17
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $162.18 / $416.87
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $67.61 / $436.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$25.12 / $38.02 / $81.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $83.18 / $147.91