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Wisconsin rates for HCPCS L3010

Foot Insert Removable Molded To Patient Model Longitudinal Arch Support Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.89 / $175.00 / $296.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.23 / $117.19 / $351.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.91 / $230.90 / $382.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.22 / $195.22 / $258.18
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.01 / $449.21 / $449.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.54 / $463.86 / $876.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.59 / $349.60 / $397.28
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.40 / $158.84 / $241.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.20 / $204.94 / $251.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.56 / $220.41 / $977.65
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.74 / $112.75 / $228.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $103.34
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.40 / $158.84 / $241.40
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.20 / $204.94 / $251.89
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.91 / $323.05 / $561.07
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.54 / $409.98 / $977.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.59 / $140.54 / $1,056.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$209.91 / $209.91 / $209.91
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$167.62 / $209.91 / $209.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.98 / $104.72 / $200.72