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Wisconsin rates for HCPCS L3923

Hand Finger Orthosis Without Joints May Include Soft Interface Straps Prefabricated Item That Has Been Trimmed Bent Molded Assembled Or Otherwise 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
$53.43 / $53.43 / $513.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.54 / $59.92 / $160.29
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.92 / $116.51 / $192.77
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.61 / $98.51 / $130.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$76.20 / $226.67 / $226.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.92 / $218.57 / $442.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.16 / $153.28 / $200.46
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.25 / $79.61 / $121.81
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.65 / $95.90 / $127.10
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.89 / $105.92 / $474.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.89 / $52.84 / $115.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.76 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.77 / $80.15 / $121.81
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.65 / $95.90 / $127.10
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.92 / $163.01 / $287.06
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.92 / $206.88 / $474.60
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.74 / $59.92 / $521.73
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.92 / $105.92 / $105.92
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.58 / $105.92 / $105.92
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.86 / $52.84 / $90.84