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Wisconsin rates for HCPCS L3765

Elbow Wrist Hand Finger Orthosis Rigid Without Joints May Include Soft Interface Straps Custom Fabricated Includes Fitting And Adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.95 / $709.29 / $815.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$671.32 / $709.29 / $1,274.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,406.03 / $1,546.63 / $2,558.96
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,252.60 / $1,307.60 / $1,729.41
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,011.50 / $3,008.90 / $3,008.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.46 / $3,104.68 / $5,868.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.46 / $1,646.43 / $2,661.03
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.54 / $1,056.83 / $1,616.93
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.06 / $1,372.31 / $1,687.24
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.27 / $1,406.03 / $6,547.41
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$613.96 / $736.53 / $1,530.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $180.06
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.54 / $1,063.94 / $1,616.93
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.06 / $1,372.31 / $1,687.24
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,406.03 / $2,163.85 / $3,759.86
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$907.46 / $2,746.16 / $6,547.41
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$662.45 / $907.46 / $7,078.87
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,406.03 / $1,406.03 / $1,406.03
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,406.03 / $1,406.03 / $1,406.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.19 / $701.45 / $1,406.03