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Wisconsin rates for HCPCS L3670

Shoulder Orthosis Acromio/Clavicular (Canvas And Webbing Type) Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.88 / $82.31 / $211.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.14 / $62.88 / $208.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.66 / $137.13 / $226.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.33 / $115.93 / $153.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$89.68 / $149.59 / $266.77
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.66 / $130.88 / $221.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.64 / $257.98 / $520.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.25 / $180.47 / $235.94
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.15 / $94.32 / $143.36
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.38 / $124.66 / $166.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$62.88 / $124.38 / $670.88
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.47 / $74.80 / $140.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.15 / $94.32 / $143.36
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.38 / $124.66 / $166.21
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.66 / $191.84 / $373.38
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.64 / $243.48 / $670.88
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.25 / $86.64 / $868.37
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.66 / $124.66 / $124.66
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.54 / $124.66 / $124.66
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.67 / $71.88 / $119.20