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Wisconsin rates for HCPCS L3925

Finger Orthosis Proximal Interphalangeal (Pip)/Distal Interphalangeal (Dip) Non Torsion Joint/Spring Extension/Flexion May Include Soft Interface Material Prefabricated Off-The-Shelf (Revised 01/01/14)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.34 / $36.34 / $36.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.33 / $36.34 / $65.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.03 / $79.23 / $131.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.98 / $66.98 / $88.59
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.82 / $154.13 / $154.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.61 / $159.30 / $300.91
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.73 / $104.53 / $136.33
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.53 / $54.51 / $82.83
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.24 / $70.31 / $86.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.16 / $75.63 / $286.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.15 / $35.93 / $78.43
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.46 / $55.00 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$17.53 / $54.51 / $82.83
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.24 / $70.31 / $86.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.03 / $108.05 / $162.60
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.61 / $140.68 / $286.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.73 / $36.61 / $338.63
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.03 / $72.03 / $72.03
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.51 / $72.03 / $72.03
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.96 / $35.93 / $67.88