go back

Wisconsin rates for HCPCS L3675

Shoulder orthosis (SO), vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf

Facilitymedian $195 · 10th–90th $158$3550%20%40%10th90th$195Professionalmedian $132 · 10th–90th $85$3240%20%10th90th$132$0.2$1.0$5.0$20.0$100.0$500.0

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
$97.72 / $97.72 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $97.72 / $199.53
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $194.98 / $323.59
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $181.97 / $218.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $457.09 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $281.84 / $371.54
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $158.49 / $245.47
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $234.42 / $295.12
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $190.55 / $891.25
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $102.33 / $213.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $70.79 / $109.65
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $309.03
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $223.87 / $389.05
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $295.12 / $537.03
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$107.15 / $389.05 / $891.25
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $158.49 / $977.24
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $100.00 / $194.98
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $95.50 / $162.18