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Wisconsin rates for HCPCS L3674

Shoulder Orthosis Abduction Positioning (Airplanedesign) Thoracic Component And Support Bar With Or Without Nontorsion Joint/Turnbuckle May Include Soft Interface Straps Custom Fabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$653.85 / $653.85 / $653.85
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.87 / $653.85 / $1,175.33
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,296.14 / $1,425.75 / $2,358.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,166.52 / $1,205.41 / $1,594.25
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$932.44 / $2,773.74 / $2,773.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.52 / $2,862.24 / $5,410.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.16 / $1,878.28 / $2,453.04
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$653.85 / $1,031.83 / $1,490.56
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,265.07 / $1,296.14 / $1,555.37
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$810.25 / $1,296.14 / $6,035.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$578.60 / $687.12 / $1,418.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $754.50
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$653.85 / $1,036.91 / $1,490.56
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,265.07 / $1,296.14 / $1,555.37
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.14 / $1,994.72 / $3,465.78
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.52 / $2,531.52 / $6,035.75
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$528.16 / $723.52 / $6,525.74
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.14 / $1,296.14 / $1,296.14
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,296.14 / $1,296.14 / $1,296.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$481.38 / $667.61 / $1,239.36