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Wisconsin rates for HCPCS L3912

Hand Finger Orthosis (Hfo) Flexion Glove With Elastic Finger Control Prefabricated Off-The- Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.28 / $58.28 / $58.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.32 / $59.38 / $96.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.53 / $127.08 / $210.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$99.91 / $107.44 / $142.10
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.11 / $247.23 / $247.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.37 / $239.22 / $482.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.45 / $167.34 / $218.65
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.67 / $86.84 / $132.86
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.15 / $115.53 / $139.40
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.28 / $115.53 / $557.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.22 / $62.04 / $130.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.67 / $87.42 / $132.86
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.15 / $115.53 / $139.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.53 / $177.80 / $313.14
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.37 / $225.64 / $557.39
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.45 / $66.37 / $694.67
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.53 / $115.53 / $115.53
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.25 / $115.53 / $115.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.47 / $57.90 / $110.47