go back

Wisconsin rates for HCPCS L3650

Shoulder Orthosis Figure Of Eight Design Abduction Restrainer Prefabricated Off-The-Shelf(Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.86 / $39.86 / $333.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.34 / $39.86 / $56.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.02 / $86.92 / $143.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.34 / $73.48 / $97.19
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.85 / $169.10 / $169.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $163.22 / $330.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $114.38 / $149.55
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.06 / $59.39 / $90.87
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.24 / $79.02 / $94.82
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.45 / $79.02 / $352.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.48 / $39.42 / $86.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.16 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.06 / $59.79 / $90.87
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.24 / $79.02 / $94.82
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.02 / $118.53 / $195.72
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.70 / $154.34 / $352.17
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.09 / $46.70 / $425.75
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.02 / $79.02 / $79.02
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $79.02 / $79.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.62 / $104.62 / $104.62
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.19 / $39.42 / $81.56