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Wisconsin rates for HCPCS L3901

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,174.36 / $1,174.36 / $1,174.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$917.07 / $1,174.36 / $1,741.67
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,327.96 / $2,560.77 / $4,236.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,165.01 / $2,165.01 / $2,863.40
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,674.73 / $4,981.85 / $4,981.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $4,813.29 / $9,717.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,107.01 / $2,725.86 / $4,405.85
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.59 / $1,761.56 / $2,677.17
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.94 / $2,149.73 / $2,793.56
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$987.72 / $2,327.96 / $9,312.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.84 / $1,161.40 / $2,534.88
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,223.17
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$570.59 / $1,761.56 / $2,677.17
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.94 / $2,149.73 / $2,793.56
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,327.96 / $3,491.96 / $5,303.55
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,107.01 / $4,546.82 / $9,312.17
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$808.12 / $1,107.01 / $11,304.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,327.96 / $2,327.96 / $2,327.96
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,327.96 / $2,327.96 / $2,327.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$736.54 / $1,161.40 / $2,064.02