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Wisconsin rates for HCPCS L6370

Interscapular Thoracic Passive Restoration (Shoulder Cap Only)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,491.24 / $1,491.24 / $1,491.24
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.90 / $1,491.24 / $2,476.02
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,956.10 / $3,251.71 / $5,380.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,660.49 / $2,749.17 / $3,636.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,126.60 / $6,326.05 / $6,326.05
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,523.27 / $6,111.61 / $12,338.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,111.99 / $4,283.91 / $5,594.66
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$785.15 / $2,236.86 / $3,399.52
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,692.58 / $2,956.10 / $3,547.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,359.12 / $2,956.10 / $12,771.35
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,331.58 / $1,832.01 / $3,218.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $70.00 / $1,096.64
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$785.15 / $2,236.86 / $3,399.52
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,692.58 / $2,956.10 / $3,547.32
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,956.10 / $4,549.32 / $7,296.90
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,523.27 / $5,773.64 / $12,771.35
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,111.99 / $1,523.27 / $15,761.88
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,956.10 / $2,956.10 / $2,956.10
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,956.10 / $2,956.10 / $2,956.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,624.58 / $1,624.58 / $1,624.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.17 / $1,621.58 / $2,620.92