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Wisconsin rates for HCPCS L3671

Shoulder Orthosis Shoulder Joint Design Without Joints May Includ Soft Interface Straps Prefabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$498.42 / $498.42 / $498.42
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$471.74 / $530.12 / $686.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$988.03 / $1,086.83 / $1,798.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.22 / $918.87 / $1,215.27
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$710.79 / $2,114.38 / $2,114.38
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$551.53 / $2,180.98 / $4,124.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.62 / $1,454.47 / $1,869.91
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.27 / $742.65 / $1,136.23
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$565.71 / $964.39 / $1,185.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$492.10 / $988.03 / $4,601.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$431.44 / $523.79 / $1,075.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $651.36
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$284.27 / $747.63 / $1,136.23
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$565.71 / $964.39 / $1,185.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.03 / $1,520.54 / $2,641.74
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$551.53 / $1,929.74 / $4,601.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$402.62 / $551.53 / $4,974.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$988.03 / $988.03 / $988.03
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.91 / $988.03 / $988.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$366.96 / $492.92 / $944.76