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Wisconsin rates for HCPCS L3050

Foot Arch Support Removable Premolded Metatarsal Each (Special Coverage Instructions Apply. See Mcm: 2323)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.61 / $28.61 / $28.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.08 / $30.42 / $39.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.71 / $62.38 / $103.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.03 / $52.74 / $69.75
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.79 / $121.36 / $121.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.65 / $125.22 / $236.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.10 / $82.03 / $107.33
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.30 / $42.63 / $65.22
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.47 / $55.34 / $68.05
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.24 / $56.71 / $264.05
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.76 / $29.71 / $61.75
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.93 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.30 / $42.92 / $65.22
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.47 / $55.34 / $68.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.71 / $87.29 / $151.56
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.65 / $110.76 / $264.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.10 / $31.65 / $285.55
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.71 / $56.71 / $56.71
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.29 / $56.71 / $56.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.04 / $25.04 / $29.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.60 / $29.48 / $50.28