go back

Wisconsin rates for HCPCS L3221

Orthopedic footwear, mens shoe, depth inlay, each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.36 / $44.36 / $44.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.36 / $51.61 / $82.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.15 / $82.15 / $148.74
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.63 / $69.63 / $69.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.84 / $263.00 / $368.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.99 / $98.63 / $123.28
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.24 / $66.54 / $96.58
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.75 / $73.75 / $73.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.36 / $96.58 / $460.20
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.95 / $68.72 / $112.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $85.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.24 / $66.54 / $96.58
Prevea360
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.75 / $73.75 / $73.75
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.75 / $205.09 / $266.29
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.84 / $165.66 / $460.20
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.99 / $69.84 / $611.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.74 / $132.29 / $134.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.40 / $57.53 / $102.41