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Wisconsin rates for HCPCS L3900

Wrist Hand Finger Orthosis Dynamic Flexor Hinge Reciprocal Wrist Extension/ Flexion Finger Flexion/Extension Wrist Or Finger Driven Custom-Fabricated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$896.09 / $896.09 / $896.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.95 / $896.09 / $1,553.30
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,776.32 / $1,953.95 / $3,232.90
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,651.98 / $1,651.98 / $2,184.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,277.88 / $3,801.32 / $3,801.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.35 / $3,672.59 / $7,414.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.35 / $2,079.71 / $3,361.83
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.43 / $1,344.14 / $2,042.77
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,017.07 / $1,746.47 / $2,131.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$795.30 / $1,776.32 / $7,437.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.67 / $886.19 / $1,934.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,204.17
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$459.43 / $1,344.14 / $2,042.77
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,017.07 / $1,746.47 / $2,131.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,776.32 / $2,664.48 / $4,269.74
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.35 / $3,469.38 / $7,437.46
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$650.69 / $891.35 / $8,383.06
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,776.32 / $1,776.32 / $1,776.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,418.34 / $1,776.32 / $1,776.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$590.79 / $886.19 / $1,698.53