go back

Wisconsin rates for HCPCS L3915

Wrist Hand Orthosis Includes One Or More Non- Torsion Joint(S) Elastic Bands Turnblocks May Include Soft Interface Straps Prefabricated Itemthat Has Been Trimmed Bent Molded Assembled Orotherwise Customized To Fit A Specific Patient By An Individual With Expertise (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.04 / $294.04 / $294.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.31 / $294.04 / $523.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$582.88 / $641.16 / $1,060.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$519.29 / $542.08 / $716.94
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$419.32 / $1,247.35 / $1,247.35
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.37 / $1,287.35 / $2,432.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.37 / $682.51 / $1,103.15
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.71 / $464.02 / $670.31
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.75 / $568.90 / $699.46
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.04 / $638.03 / $2,714.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.45 / $305.33 / $634.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $384.27
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$167.71 / $466.30 / $670.31
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$333.75 / $568.90 / $699.46
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.88 / $897.05 / $1,558.75
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$325.37 / $1,138.44 / $2,714.31
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.52 / $325.37 / $2,934.66
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.88 / $582.88 / $582.88
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$582.88 / $582.88 / $582.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.48 / $290.80 / $516.79