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Wisconsin rates for HCPCS L3962

Shoulder-elbow-wrist-hand orthosis (SEWHO), abduction positioning, Erb's palsy design, prefabricated, includes fitting and adjustment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.02 / $399.02 / $399.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.02 / $439.65 / $853.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.98 / $870.08 / $1,439.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$711.88 / $735.61 / $972.90
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$569.03 / $1,692.70 / $1,692.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.25 / $1,635.06 / $3,301.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $1,146.08 / $1,496.99
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.75 / $598.53 / $909.63
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.90 / $790.98 / $1,054.64
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.02 / $830.53 / $4,154.25
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$358.31 / $460.60 / $893.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $490.36
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$254.75 / $598.53 / $909.63
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$452.90 / $790.98 / $1,054.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.98 / $1,217.30 / $2,367.73
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$494.25 / $1,544.88 / $4,154.25
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.80 / $494.25 / $5,062.27
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$790.98 / $790.98 / $790.98
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$631.58 / $790.98 / $790.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$308.98 / $421.12 / $756.34