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Shoulder Orthosis (SO), Figure of Eight Abduction Restrainer

Wisconsin rates for HCPCS L3650

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

Rates data updated July 2026.

Facilitymedian $81 · 10th–90th $60$1620%50%10th90th$81Professionalmedian $74 · 10th–90th $39$1480%10%20%10th90th$74$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
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$151.36
Typical High
$331.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$39.81
Typical High
$60.26
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$81.28
Median
$81.28
Typical High
$131.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$74.13
Typical High
$91.20
Cigna
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$186.21
Typical High
$407.38
Cigna
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$117.49
Typical High
$151.36
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$64.57
Typical High
$100.00
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$95.50
Typical High
$117.49
Medica
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$79.43
Typical High
$354.81
Medica
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$39.81
Typical High
$87.10
Molina
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$58.88
Typical High
$83.18
Network Health
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$128.82
Network Health
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$91.20
Typical High
$158.49
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$64.57
Typical High
$100.00
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$45.71
Median
$79.43
Typical High
$87.10
Quartz
Setting
Professional
Modifier
Global
Typical Low
$81.28
Median
$120.23
Typical High
$194.98
Quartz
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$162.18
Typical High
$363.08
Quartz
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$120.23
Typical High
$436.52
Security Health
Setting
Professional
Modifier
Global
Typical Low
$63.10
Median
$72.44
Typical High
$74.13
United
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$38.02
Typical High
$81.28
United
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$83.18
Typical High
$147.91