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Wisconsin rates for HCPCS L3660

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.16 / $57.16 / $146.25
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.50 / $53.81 / $89.15
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.31 / $124.64 / $206.22
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.38 / $105.38 / $139.37
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.51 / $135.97 / $242.48
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.31 / $118.98 / $158.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.80 / $234.53 / $473.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.68 / $188.71 / $214.44
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.50 / $85.74 / $130.31
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.88 / $113.31 / $135.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.16 / $113.31 / $589.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.33 / $67.98 / $123.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.50 / $85.74 / $130.31
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.88 / $113.31 / $135.97
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.31 / $174.37 / $339.25
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.80 / $221.30 / $589.07
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.68 / $70.80 / $736.54
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.31 / $113.31 / $113.31
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.38 / $113.31 / $113.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.14 / $62.76 / $108.34