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Wisconsin rates for HCPCS L3916

Wrist-hand orthosis (WHO), includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $295.12 / $295.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $302.00 / $426.58
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $588.84 / $977.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $549.54 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $1,318.26 / $2,951.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $851.14 / $1,122.02
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $446.68 / $691.83
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $645.65 / $707.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $588.84 / $2,691.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $309.03 / $660.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $57.54 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $891.25 / $1,621.81
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $1,174.90 / $2,691.53
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.88 / $478.63 / $2,951.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $288.40 / $851.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $288.40 / $489.78