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Wisconsin rates for HCPCS L3030

Foot Insert Removable Formed To Patient Foot Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.38 / $46.38 / $245.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.91 / $55.00 / $258.97
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.93 / $101.12 / $167.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.49 / $85.49 / $113.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.14 / $196.73 / $196.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.54 / $203.37 / $383.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.92 / $133.13 / $173.99
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.46 / $69.11 / $105.72
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.63 / $89.75 / $110.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.79 / $91.93 / $428.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.14 / $48.16 / $100.10
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $65.00 / $92.36
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.46 / $69.56 / $105.72
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.63 / $89.75 / $110.32
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.93 / $141.49 / $245.91
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.54 / $179.56 / $428.17
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.92 / $61.54 / $839.24
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.93 / $91.93 / $91.93
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.40 / $91.93 / $91.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.15 / $45.86 / $81.51